|
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 |
$1,675.85
|
| 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 |
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 |
$1,675.85
|
| Rate for Payer: Cash Price |
$1,675.85
|
| 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 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 |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| 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
|
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 |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| 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 |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| 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
|
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 |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| 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 |
$233.75
|
| 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
|
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 |
$233.75
|
| 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 |
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 |
$233.75
|
| Rate for Payer: Cash Price |
$233.75
|
| 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 |
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 |
$233.75
|
| Rate for Payer: Cash Price |
$233.75
|
| 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 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 |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| 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 |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| 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 |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| 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 |
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 |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| 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 FULL CORSET
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
905350976
|
|
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 |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| 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
|
|
|
HC LSO FULL CORSET
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
915350976
|
|
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 |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| 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 |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| 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
|
|
|
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 |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| 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 POST RIGID PANEL PRE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT L0630
|
| Hospital Charge Code |
905350630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.08
|
| Rate for Payer: United Healthcare All Other HMO |
$102.28
|
| Rate for Payer: United Healthcare HMO Rider |
$100.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.70
|
|
|
HC LSO POST RIGID PANEL PRE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT L0630
|
| Hospital Charge Code |
915350630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.08
|
| Rate for Payer: United Healthcare All Other HMO |
$102.28
|
| Rate for Payer: United Healthcare HMO Rider |
$100.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.70
|
|
|
HC LSO POST RIGID PANEL PRE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L0630
|
| Hospital Charge Code |
905350630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.18
|
| Rate for Payer: Blue Shield of California Commercial |
$206.64
|
| Rate for Payer: Blue Shield of California EPN |
$136.08
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.08
|
| Rate for Payer: United Healthcare All Other HMO |
$102.28
|
| Rate for Payer: United Healthcare HMO Rider |
$100.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC LSO POST RIGID PANEL PRE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L0630
|
| Hospital Charge Code |
915350630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.18
|
| Rate for Payer: Blue Shield of California Commercial |
$206.64
|
| Rate for Payer: Blue Shield of California EPN |
$136.08
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.08
|
| Rate for Payer: United Healthcare All Other HMO |
$102.28
|
| Rate for Payer: United Healthcare HMO Rider |
$100.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC LSO SAG-CORONAL PANEL CUSTOM
|
Facility
|
OP
|
$2,220.00
|
|
|
Service Code
|
CPT L0638
|
| Hospital Charge Code |
905350638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.80 |
| Max. Negotiated Rate |
$1,887.00 |
| Rate for Payer: Adventist Health Commercial |
$910.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,221.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,285.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,638.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,078.92
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cigna of CA HMO |
$1,554.00
|
| Rate for Payer: Cigna of CA PPO |
$1,554.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,887.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,887.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.00
|
| Rate for Payer: EPIC Health Plan Senior |
$888.00
|
| Rate for Payer: Galaxy Health WC |
$1,887.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,392.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,374.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,554.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,554.00
|
| Rate for Payer: Multiplan Commercial |
$1,776.00
|
| Rate for Payer: Networks By Design Commercial |
$1,110.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,887.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,332.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,332.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$833.17
|
| Rate for Payer: United Healthcare All Other HMO |
$810.97
|
| Rate for Payer: United Healthcare HMO Rider |
$793.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,887.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,887.00
|
|
|
HC LSO SAG-CORONAL PANEL CUSTOM
|
Facility
|
OP
|
$2,220.00
|
|
|
Service Code
|
CPT L0638
|
| Hospital Charge Code |
915350638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.80 |
| Max. Negotiated Rate |
$1,887.00 |
| Rate for Payer: Adventist Health Commercial |
$910.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,221.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,285.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,638.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,078.92
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cigna of CA HMO |
$1,554.00
|
| Rate for Payer: Cigna of CA PPO |
$1,554.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,887.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,887.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.00
|
| Rate for Payer: EPIC Health Plan Senior |
$888.00
|
| Rate for Payer: Galaxy Health WC |
$1,887.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,392.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,374.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,554.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,554.00
|
| Rate for Payer: Multiplan Commercial |
$1,776.00
|
| Rate for Payer: Networks By Design Commercial |
$1,110.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,887.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,332.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,332.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$833.17
|
| Rate for Payer: United Healthcare All Other HMO |
$810.97
|
| Rate for Payer: United Healthcare HMO Rider |
$793.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,887.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,887.00
|
|
|
HC LSO SAG-CORONAL PANEL CUSTOM
|
Facility
|
IP
|
$2,220.00
|
|
|
Service Code
|
CPT L0638
|
| Hospital Charge Code |
905350638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$444.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cigna of CA HMO |
$1,554.00
|
| Rate for Payer: Cigna of CA PPO |
$1,554.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.00
|
| Rate for Payer: EPIC Health Plan Senior |
$888.00
|
| Rate for Payer: Galaxy Health WC |
$1,887.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,332.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,374.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.80
|
| Rate for Payer: Multiplan Commercial |
$1,776.00
|
| Rate for Payer: Networks By Design Commercial |
$1,110.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,887.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$833.17
|
| Rate for Payer: United Healthcare All Other HMO |
$810.97
|
| Rate for Payer: United Healthcare HMO Rider |
$793.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.05
|
|
