|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: EPIC Health Plan Senior |
$249.60
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$416.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
|
|
HC LRNGSCPY, FLXBL W BX OR BXS
|
Facility
|
OP
|
$3,520.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
900500576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$704.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Cigna of CA HMO |
$2,252.80
|
| Rate for Payer: Cigna of CA PPO |
$2,604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$2,816.00
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,760.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,760.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,760.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,760.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC LRNGSCPY, FLXBL W BX OR BXS
|
Facility
|
IP
|
$3,520.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
900500576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$704.00 |
| Max. Negotiated Rate |
$2,992.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,408.00
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,341.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,178.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.80
|
| Rate for Payer: Multiplan Commercial |
$2,816.00
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
|
|
HC LSO CORSET FRONT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
915350972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
|
|
HC LSO CORSET FRONT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
905350972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
|
|
HC LSO CORSET FRONT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
915350972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: Adventist Health Commercial |
$167.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.31
|
| Rate for Payer: Blue Shield of California Commercial |
$301.10
|
| Rate for Payer: Blue Shield of California EPN |
$198.29
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC LSO CORSET FRONT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
905350972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: Adventist Health Commercial |
$167.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.31
|
| Rate for Payer: Blue Shield of California Commercial |
$301.10
|
| Rate for Payer: Blue Shield of California EPN |
$198.29
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 CUSTOM
|
Facility
|
OP
|
$3,047.00
|
|
|
Service Code
|
CPT L0629
|
| Hospital Charge Code |
905350629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$731.28 |
| Max. Negotiated Rate |
$2,589.95 |
| Rate for Payer: Adventist Health Commercial |
$1,249.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,675.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,285.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,764.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,248.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.84
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,589.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,589.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,886.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,132.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,132.90
|
| Rate for Payer: Multiplan Commercial |
$2,437.60
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,828.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,828.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,589.95
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 CUSTOM
|
Facility
|
IP
|
$3,047.00
|
|
|
Service Code
|
CPT L0629
|
| Hospital Charge Code |
915350629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$609.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,160.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,886.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.28
|
| Rate for Payer: Multiplan Commercial |
$2,437.60
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.89
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 CUSTOM
|
Facility
|
IP
|
$3,047.00
|
|
|
Service Code
|
CPT L0629
|
| Hospital Charge Code |
905350629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$609.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,160.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,886.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.28
|
| Rate for Payer: Multiplan Commercial |
$2,437.60
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.89
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 CUSTOM
|
Facility
|
OP
|
$3,047.00
|
|
|
Service Code
|
CPT L0629
|
| Hospital Charge Code |
915350629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$731.28 |
| Max. Negotiated Rate |
$2,589.95 |
| Rate for Payer: Adventist Health Commercial |
$1,249.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,675.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,285.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,764.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,248.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.84
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,589.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,589.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,886.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,132.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,132.90
|
| Rate for Payer: Multiplan Commercial |
$2,437.60
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,828.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,828.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,589.95
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 PREFAB
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT L0628
|
| Hospital Charge Code |
905340628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 PREFAB
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT L0628
|
| Hospital Charge Code |
905340628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Adventist Health Commercial |
$77.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.05
|
| Rate for Payer: Blue Shield of California Commercial |
$140.22
|
| Rate for Payer: Blue Shield of California EPN |
$92.34
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$161.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.50
|
| Rate for Payer: Vantage Medical Group Senior |
$161.50
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 PREFAB
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT L0628
|
| Hospital Charge Code |
915340628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 PREFAB
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT L0628
|
| Hospital Charge Code |
915340628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Adventist Health Commercial |
$77.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.05
|
| Rate for Payer: Blue Shield of California Commercial |
$140.22
|
| Rate for Payer: Blue Shield of California EPN |
$92.34
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$161.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.50
|
| Rate for Payer: Vantage Medical Group Senior |
$161.50
|
|
|
HC LSO, FLEXION CONTROL, CUSTOM
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT L0634
|
| Hospital Charge Code |
915350634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$361.25 |
| Rate for Payer: Adventist Health Commercial |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$361.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$233.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$318.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.16
|
| Rate for Payer: Blue Shield of California Commercial |
$313.65
|
| Rate for Payer: Blue Shield of California EPN |
$206.55
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cigna of CA HMO |
$297.50
|
| Rate for Payer: Cigna of CA PPO |
$297.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$361.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$361.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$361.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$263.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$297.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$297.50
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Networks By Design Commercial |
$212.50
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.25
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$361.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$361.25
|
| Rate for Payer: Vantage Medical Group Senior |
$361.25
|
|
|
HC LSO, FLEXION CONTROL, CUSTOM
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT L0634
|
| Hospital Charge Code |
905350634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$85.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cigna of CA HMO |
$297.50
|
| Rate for Payer: Cigna of CA PPO |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$263.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Networks By Design Commercial |
$212.50
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.25
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.19
|
|
|
HC LSO, FLEXION CONTROL, CUSTOM
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT L0634
|
| Hospital Charge Code |
915350634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$85.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cigna of CA HMO |
$297.50
|
| Rate for Payer: Cigna of CA PPO |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$263.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Networks By Design Commercial |
$212.50
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.25
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.19
|
|
|
HC LSO, FLEXION CONTROL, CUSTOM
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT L0634
|
| Hospital Charge Code |
905350634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$361.25 |
| Rate for Payer: Adventist Health Commercial |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$361.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$233.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$318.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.16
|
| Rate for Payer: Blue Shield of California Commercial |
$313.65
|
| Rate for Payer: Blue Shield of California EPN |
$206.55
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cigna of CA HMO |
$297.50
|
| Rate for Payer: Cigna of CA PPO |
$297.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$361.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$361.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$361.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$263.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$297.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$297.50
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Networks By Design Commercial |
$212.50
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.25
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$361.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$361.25
|
| Rate for Payer: Vantage Medical Group Senior |
$361.25
|
|
|
HC LSO FLEXION CONTROL PREFAB
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT L0633
|
| Hospital Charge Code |
905350633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.43
|
| Rate for Payer: Blue Shield of California Commercial |
$339.48
|
| Rate for Payer: Blue Shield of California EPN |
$223.56
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna of CA HMO |
$322.00
|
| Rate for Payer: Cigna of CA PPO |
$322.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$302.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: Networks By Design Commercial |
$230.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.64
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$164.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC LSO FLEXION CONTROL PREFAB
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT L0633
|
| Hospital Charge Code |
905350633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna of CA HMO |
$322.00
|
| Rate for Payer: Cigna of CA PPO |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: Networks By Design Commercial |
$230.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.64
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$164.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.65
|
|
|
HC LSO FLEXION CONTROL PREFAB
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT L0633
|
| Hospital Charge Code |
915350633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.43
|
| Rate for Payer: Blue Shield of California Commercial |
$339.48
|
| Rate for Payer: Blue Shield of California EPN |
$223.56
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna of CA HMO |
$322.00
|
| Rate for Payer: Cigna of CA PPO |
$322.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$302.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: Networks By Design Commercial |
$230.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.64
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$164.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC LSO FLEXION CONTROL PREFAB
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT L0633
|
| Hospital Charge Code |
915350633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna of CA HMO |
$322.00
|
| Rate for Payer: Cigna of CA PPO |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: Networks By Design Commercial |
$230.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.64
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$164.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.65
|
|
|
HC LSO FULL CORSET
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
905350976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$134.00
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
|
|
HC LSO FULL CORSET
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
915350976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.23
|
| Rate for Payer: Blue Shield of California Commercial |
$197.78
|
| Rate for Payer: Blue Shield of California EPN |
$130.25
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$134.00
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
