|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
905350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.91 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$287.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.35
|
| Rate for Payer: Blue Shield of California Commercial |
$563.00
|
| Rate for Payer: Blue Shield of California EPN |
$353.81
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$374.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$414.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
905350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Blue Shield of California Commercial |
$563.00
|
| Rate for Payer: Blue Shield of California EPN |
$353.81
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
915350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Blue Shield of California Commercial |
$563.00
|
| Rate for Payer: Blue Shield of California EPN |
$353.81
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
915350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Adventist Health Commercial |
$312.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,253.53
|
| Rate for Payer: Blue Shield of California EPN |
$787.75
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$922.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.60
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$1,015.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
915350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.88 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Adventist Health Commercial |
$640.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,172.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$909.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,253.53
|
| Rate for Payer: Blue Shield of California EPN |
$787.75
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,328.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,328.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,075.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$922.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,094.10
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: Riverside University Health System MISP |
$625.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,328.55
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
905350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Adventist Health Commercial |
$312.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,253.53
|
| Rate for Payer: Blue Shield of California EPN |
$787.75
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$922.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.60
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$1,015.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
905350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.88 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Adventist Health Commercial |
$640.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,172.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$909.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,253.53
|
| Rate for Payer: Blue Shield of California EPN |
$787.75
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,328.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,328.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,075.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$922.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,094.10
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: Riverside University Health System MISP |
$625.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,328.55
|
|
|
HC TLSO FULL CORSET
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
905350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.06 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Adventist Health Commercial |
$136.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$183.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.71
|
| Rate for Payer: Blue Shield of California Commercial |
$267.07
|
| Rate for Payer: Blue Shield of California EPN |
$167.83
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$283.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$233.10
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$166.50
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: Riverside University Health System MISP |
$133.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.05
|
| Rate for Payer: Vantage Medical Group Senior |
$283.05
|
|
|
HC TLSO FULL CORSET
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
905350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Blue Shield of California Commercial |
$267.07
|
| Rate for Payer: Blue Shield of California EPN |
$167.83
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.60
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$216.45
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
|
|
HC TLSO FULL CORSET
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
915350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.06 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Adventist Health Commercial |
$136.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$183.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.71
|
| Rate for Payer: Blue Shield of California Commercial |
$267.07
|
| Rate for Payer: Blue Shield of California EPN |
$167.83
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$283.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$233.10
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$166.50
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: Riverside University Health System MISP |
$133.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.05
|
| Rate for Payer: Vantage Medical Group Senior |
$283.05
|
|
|
HC TLSO FULL CORSET
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
915350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Blue Shield of California Commercial |
$267.07
|
| Rate for Payer: Blue Shield of California EPN |
$167.83
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.60
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$216.45
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
IP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
905351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,026.60 |
| Max. Negotiated Rate |
$4,619.70 |
| Rate for Payer: Adventist Health Commercial |
$1,026.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,116.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,587.03
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,106.40
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,593.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,619.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,259.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,028.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.60
|
| Rate for Payer: Multiplan Commercial |
$3,849.75
|
| Rate for Payer: Networks By Design Commercial |
$3,336.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.06
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
OP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
915351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,681.06 |
| Max. Negotiated Rate |
$4,619.70 |
| Rate for Payer: Adventist Health Commercial |
$2,104.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,823.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,849.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,985.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4,116.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,587.03
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,106.40
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,363.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,363.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,593.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,619.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,129.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,259.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,351.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,028.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,104.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,593.10
|
| Rate for Payer: Multiplan Commercial |
$3,849.75
|
| Rate for Payer: Networks By Design Commercial |
$2,566.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,053.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,079.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,079.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,363.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,363.05
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
OP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
905351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,681.06 |
| Max. Negotiated Rate |
$4,619.70 |
| Rate for Payer: Adventist Health Commercial |
$2,104.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,823.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,849.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,985.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4,116.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,587.03
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,106.40
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,363.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,363.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,593.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,619.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,129.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,259.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,351.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,028.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,104.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,593.10
|
| Rate for Payer: Multiplan Commercial |
$3,849.75
|
| Rate for Payer: Networks By Design Commercial |
$2,566.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,053.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,079.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,079.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,363.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,363.05
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
IP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
915351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,026.60 |
| Max. Negotiated Rate |
$4,619.70 |
| Rate for Payer: Adventist Health Commercial |
$1,026.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,116.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,587.03
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,106.40
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,593.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,619.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,259.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,028.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.60
|
| Rate for Payer: Multiplan Commercial |
$3,849.75
|
| Rate for Payer: Networks By Design Commercial |
$3,336.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,875.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,681.06
|
|
|
HC TLSO KNIGHT TAYLOR
|
Facility
|
IP
|
$790.00
|
|
| Hospital Charge Code |
905350330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$633.58
|
| Rate for Payer: Blue Shield of California EPN |
$398.16
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Central Health Plan Commercial |
$632.00
|
| Rate for Payer: Cigna of CA HMO |
$553.00
|
| Rate for Payer: Cigna of CA PPO |
$553.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$553.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.00
|
| Rate for Payer: EPIC Health Plan Senior |
$316.00
|
| Rate for Payer: Galaxy Health WC |
$671.50
|
| Rate for Payer: Global Benefits Group Commercial |
$474.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$711.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$501.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$466.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.00
|
| Rate for Payer: Multiplan Commercial |
$592.50
|
| Rate for Payer: Networks By Design Commercial |
$513.50
|
| Rate for Payer: Prime Health Services Commercial |
$671.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$296.49
|
| Rate for Payer: United Healthcare All Other HMO |
$288.59
|
| Rate for Payer: United Healthcare HMO Rider |
$282.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.73
|
|
|
HC TLSO KNIGHT TAYLOR
|
Facility
|
OP
|
$790.00
|
|
| Hospital Charge Code |
905350330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.73 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$323.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$671.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$592.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.54
|
| Rate for Payer: Blue Shield of California Commercial |
$633.58
|
| Rate for Payer: Blue Shield of California EPN |
$398.16
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Central Health Plan Commercial |
$632.00
|
| Rate for Payer: Cigna of CA HMO |
$553.00
|
| Rate for Payer: Cigna of CA PPO |
$553.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$671.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$671.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$671.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$553.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.00
|
| Rate for Payer: EPIC Health Plan Senior |
$316.00
|
| Rate for Payer: Galaxy Health WC |
$671.50
|
| Rate for Payer: Global Benefits Group Commercial |
$474.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$711.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$501.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$466.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$553.00
|
| Rate for Payer: Multiplan Commercial |
$592.50
|
| Rate for Payer: Networks By Design Commercial |
$395.00
|
| Rate for Payer: Prime Health Services Commercial |
$671.50
|
| Rate for Payer: Riverside University Health System MISP |
$316.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$296.49
|
| Rate for Payer: United Healthcare All Other HMO |
$288.59
|
| Rate for Payer: United Healthcare HMO Rider |
$282.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$671.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$671.50
|
| Rate for Payer: Vantage Medical Group Senior |
$671.50
|
|
|
HC TLSO LAT THORACIC EXTENSION
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT L1210
|
| Hospital Charge Code |
905351210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Blue Shield of California Commercial |
$378.54
|
| Rate for Payer: Blue Shield of California EPN |
$237.89
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
|
|
HC TLSO LAT THORACIC EXTENSION
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT L1210
|
| Hospital Charge Code |
915351210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Blue Shield of California Commercial |
$378.54
|
| Rate for Payer: Blue Shield of California EPN |
$237.89
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
|
|
HC TLSO LAT THORACIC EXTENSION
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT L1210
|
| Hospital Charge Code |
915351210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.58 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$193.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.56
|
| Rate for Payer: Blue Shield of California Commercial |
$378.54
|
| Rate for Payer: Blue Shield of California EPN |
$237.89
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$240.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$236.00
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: Riverside University Health System MISP |
$188.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC TLSO LAT THORACIC EXTENSION
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT L1210
|
| Hospital Charge Code |
905351210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.58 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$193.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.56
|
| Rate for Payer: Blue Shield of California Commercial |
$378.54
|
| Rate for Payer: Blue Shield of California EPN |
$237.89
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$240.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$236.00
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: Riverside University Health System MISP |
$188.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
905351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$175.64
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.80
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$142.35
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
915351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$175.64
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.80
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$142.35
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
915351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$89.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.39
|
| Rate for Payer: Blue Shield of California Commercial |
$175.64
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$153.30
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: Riverside University Health System MISP |
$87.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
905351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$89.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.39
|
| Rate for Payer: Blue Shield of California Commercial |
$175.64
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$153.30
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: Riverside University Health System MISP |
$87.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
