|
HC TLSO LAT THORACIC EXTENSION
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT L1210
|
| Hospital Charge Code |
905351210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.28
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
915351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$186.15 |
| Rate for Payer: Adventist Health Commercial |
$89.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.56
|
| Rate for Payer: Blue Shield of California Commercial |
$168.41
|
| Rate for Payer: Blue Shield of California Commercial |
$111.03
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$153.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$153.30
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
915351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$43.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.56
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: Networks By Design Commercial |
$142.35
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
905351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$186.15 |
| Rate for Payer: Adventist Health Commercial |
$89.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.56
|
| Rate for Payer: Blue Shield of California Commercial |
$168.41
|
| Rate for Payer: Blue Shield of California Commercial |
$111.03
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$153.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$153.30
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
905351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$43.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.56
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: Networks By Design Commercial |
$142.35
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
|
|
HC TLSO LUMBAR DEROTATION PAD
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L1240
|
| Hospital Charge Code |
905351240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC TLSO LUMBAR DEROTATION PAD
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L1240
|
| Hospital Charge Code |
915351240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC TLSO LUMBAR DEROTATION PAD
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L1240
|
| Hospital Charge Code |
915351240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.90
|
| Rate for Payer: Blue Shield of California Commercial |
$66.92
|
| Rate for Payer: Blue Shield of California Commercial |
$101.51
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC TLSO LUMBAR DEROTATION PAD
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L1240
|
| Hospital Charge Code |
905351240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.90
|
| Rate for Payer: Blue Shield of California Commercial |
$66.92
|
| Rate for Payer: Blue Shield of California Commercial |
$101.51
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC TLSO MILWAUKEE SUPERSTRUCTURE
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT L1230
|
| Hospital Charge Code |
915351230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$666.40 |
| Rate for Payer: Adventist Health Commercial |
$321.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$588.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$474.56
|
| Rate for Payer: Blue Shield of California Commercial |
$602.90
|
| Rate for Payer: Blue Shield of California Commercial |
$397.49
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$548.80
|
| Rate for Payer: Cigna of CA PPO |
$548.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$666.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$666.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$666.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$548.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$548.80
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: Networks By Design Commercial |
$392.00
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$470.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$294.24
|
| Rate for Payer: United Healthcare All Other HMO |
$286.40
|
| Rate for Payer: United Healthcare HMO Rider |
$280.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$666.40
|
| Rate for Payer: Vantage Medical Group Senior |
$666.40
|
|
|
HC TLSO MILWAUKEE SUPERSTRUCTURE
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT L1230
|
| Hospital Charge Code |
915351230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$548.80
|
| Rate for Payer: Cigna of CA PPO |
$548.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.16
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: Networks By Design Commercial |
$509.60
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$294.24
|
| Rate for Payer: United Healthcare All Other HMO |
$286.40
|
| Rate for Payer: United Healthcare HMO Rider |
$280.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.76
|
|
|
HC TLSO MILWAUKEE SUPERSTRUCTURE
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT L1230
|
| Hospital Charge Code |
905351230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$548.80
|
| Rate for Payer: Cigna of CA PPO |
$548.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.16
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: Networks By Design Commercial |
$509.60
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$294.24
|
| Rate for Payer: United Healthcare All Other HMO |
$286.40
|
| Rate for Payer: United Healthcare HMO Rider |
$280.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.76
|
|
|
HC TLSO MILWAUKEE SUPERSTRUCTURE
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT L1230
|
| Hospital Charge Code |
905351230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$666.40 |
| Rate for Payer: Adventist Health Commercial |
$321.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$588.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$474.56
|
| Rate for Payer: Blue Shield of California Commercial |
$602.90
|
| Rate for Payer: Blue Shield of California Commercial |
$397.49
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$548.80
|
| Rate for Payer: Cigna of CA PPO |
$548.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$666.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$666.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$666.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$548.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$548.80
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: Networks By Design Commercial |
$392.00
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$470.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$294.24
|
| Rate for Payer: United Healthcare All Other HMO |
$286.40
|
| Rate for Payer: United Healthcare HMO Rider |
$280.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$666.40
|
| Rate for Payer: Vantage Medical Group Senior |
$666.40
|
|
|
HC TLSO RIB GUSSET
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L1280
|
| Hospital Charge Code |
915351280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Adventist Health Commercial |
$90.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.77
|
| Rate for Payer: Blue Shield of California Commercial |
$169.95
|
| Rate for Payer: Blue Shield of California Commercial |
$112.05
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$108.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.70
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC TLSO RIB GUSSET
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L1280
|
| Hospital Charge Code |
905351280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Adventist Health Commercial |
$90.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.77
|
| Rate for Payer: Blue Shield of California Commercial |
$169.95
|
| Rate for Payer: Blue Shield of California Commercial |
$112.05
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$108.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.70
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC TLSO RIB GUSSET
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT L1280
|
| Hospital Charge Code |
915351280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
|
|
HC TLSO RIB GUSSET
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT L1280
|
| Hospital Charge Code |
905351280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
|
|
HC TLSO SAGITTAL CNTRL RIGID POST FRAME SFT APRON
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT L0466
|
| Hospital Charge Code |
905350466
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Adventist Health Commercial |
$307.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.98
|
| Rate for Payer: Blue Shield of California Commercial |
$576.75
|
| Rate for Payer: Blue Shield of California Commercial |
$380.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna of CA HMO |
$525.00
|
| Rate for Payer: Cigna of CA PPO |
$525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$637.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$569.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$375.00
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.48
|
| Rate for Payer: United Healthcare All Other HMO |
$273.98
|
| Rate for Payer: United Healthcare HMO Rider |
$268.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.50
|
| Rate for Payer: Vantage Medical Group Senior |
$637.50
|
|
|
HC TLSO SAGITTAL CNTRL RIGID POST FRAME SFT APRON
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT L0466
|
| Hospital Charge Code |
915350466
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Adventist Health Commercial |
$307.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.98
|
| Rate for Payer: Blue Shield of California Commercial |
$576.75
|
| Rate for Payer: Blue Shield of California Commercial |
$380.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna of CA HMO |
$525.00
|
| Rate for Payer: Cigna of CA PPO |
$525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$637.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$569.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$375.00
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.48
|
| Rate for Payer: United Healthcare All Other HMO |
$273.98
|
| Rate for Payer: United Healthcare HMO Rider |
$268.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.50
|
| Rate for Payer: Vantage Medical Group Senior |
$637.50
|
|
|
HC TLSO SAGITTAL CNTRL RIGID POST FRAME SFT APRON
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT L0466
|
| Hospital Charge Code |
915350466
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna of CA HMO |
$525.00
|
| Rate for Payer: Cigna of CA PPO |
$525.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.48
|
| Rate for Payer: United Healthcare All Other HMO |
$273.98
|
| Rate for Payer: United Healthcare HMO Rider |
$268.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.62
|
|
|
HC TLSO SAGITTAL CNTRL RIGID POST FRAME SFT APRON
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT L0466
|
| Hospital Charge Code |
905350466
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna of CA HMO |
$525.00
|
| Rate for Payer: Cigna of CA PPO |
$525.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.48
|
| Rate for Payer: United Healthcare All Other HMO |
$273.98
|
| Rate for Payer: United Healthcare HMO Rider |
$268.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.62
|
|
|
HC TLSO SAGITTAL CORONAL CONTROL ONE PIECE
|
Facility
|
OP
|
$2,249.00
|
|
|
Service Code
|
CPT L0490
|
| Hospital Charge Code |
905350490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$298.74 |
| Max. Negotiated Rate |
$1,911.65 |
| Rate for Payer: Adventist Health Commercial |
$922.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,236.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,686.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,361.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,729.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,140.24
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cigna of CA HMO |
$1,574.30
|
| Rate for Payer: Cigna of CA PPO |
$1,574.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,911.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,911.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,574.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$899.60
|
| Rate for Payer: Galaxy Health WC |
$1,911.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,349.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$298.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,428.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,326.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,574.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,574.30
|
| Rate for Payer: Multiplan Commercial |
$1,799.20
|
| Rate for Payer: Networks By Design Commercial |
$1,124.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,911.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,349.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,349.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$844.05
|
| Rate for Payer: United Healthcare All Other HMO |
$821.56
|
| Rate for Payer: United Healthcare HMO Rider |
$803.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,911.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,911.65
|
|
|
HC TLSO SAGITTAL CORONAL CONTROL ONE PIECE
|
Facility
|
IP
|
$2,249.00
|
|
|
Service Code
|
CPT L0490
|
| Hospital Charge Code |
915350490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$449.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cigna of CA HMO |
$1,574.30
|
| Rate for Payer: Cigna of CA PPO |
$1,574.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,574.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$899.60
|
| Rate for Payer: Galaxy Health WC |
$1,911.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,349.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,428.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,326.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.76
|
| Rate for Payer: Multiplan Commercial |
$1,799.20
|
| Rate for Payer: Networks By Design Commercial |
$1,461.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,911.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$844.05
|
| Rate for Payer: United Healthcare All Other HMO |
$821.56
|
| Rate for Payer: United Healthcare HMO Rider |
$803.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.55
|
|
|
HC TLSO SAGITTAL CORONAL CONTROL ONE PIECE
|
Facility
|
OP
|
$2,249.00
|
|
|
Service Code
|
CPT L0490
|
| Hospital Charge Code |
915350490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$298.74 |
| Max. Negotiated Rate |
$1,911.65 |
| Rate for Payer: Adventist Health Commercial |
$922.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,236.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,686.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,361.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,729.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,140.24
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cigna of CA HMO |
$1,574.30
|
| Rate for Payer: Cigna of CA PPO |
$1,574.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,911.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,911.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,574.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$899.60
|
| Rate for Payer: Galaxy Health WC |
$1,911.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,349.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$298.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,428.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,326.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,574.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,574.30
|
| Rate for Payer: Multiplan Commercial |
$1,799.20
|
| Rate for Payer: Networks By Design Commercial |
$1,124.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,911.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,349.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,349.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$844.05
|
| Rate for Payer: United Healthcare All Other HMO |
$821.56
|
| Rate for Payer: United Healthcare HMO Rider |
$803.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,911.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,911.65
|
|
|
HC TLSO SAGITTAL CORONAL CONTROL ONE PIECE
|
Facility
|
IP
|
$2,249.00
|
|
|
Service Code
|
CPT L0490
|
| Hospital Charge Code |
905350490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$449.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cigna of CA HMO |
$1,574.30
|
| Rate for Payer: Cigna of CA PPO |
$1,574.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,574.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$899.60
|
| Rate for Payer: Galaxy Health WC |
$1,911.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,349.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,428.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,326.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.76
|
| Rate for Payer: Multiplan Commercial |
$1,799.20
|
| Rate for Payer: Networks By Design Commercial |
$1,461.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,911.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$844.05
|
| Rate for Payer: United Healthcare All Other HMO |
$821.56
|
| Rate for Payer: United Healthcare HMO Rider |
$803.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.55
|
|
