|
HC TLSO LUMBAR DEROTATION PAD
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L1240
|
| Hospital Charge Code |
905351240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$105.86
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC TLSO LUMBAR DEROTATION PAD
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L1240
|
| Hospital Charge Code |
915351240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.78
|
| Rate for Payer: Blue Shield of California Commercial |
$105.86
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC TLSO LUMBAR DEROTATION PAD
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L1240
|
| Hospital Charge Code |
905351240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.78
|
| Rate for Payer: Blue Shield of California Commercial |
$105.86
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC TLSO LUMBAR DEROTATION PAD
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L1240
|
| Hospital Charge Code |
915351240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$105.86
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC TLSO MILWAUKEE SUPERSTRUCTURE
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT L1230
|
| Hospital Charge Code |
905351230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Blue Shield of California Commercial |
$628.77
|
| Rate for Payer: Blue Shield of California EPN |
$395.14
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Central Health Plan Commercial |
$627.20
|
| Rate for Payer: Cigna of CA HMO |
$548.80
|
| Rate for Payer: Cigna of CA PPO |
$548.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$705.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: Networks By Design Commercial |
$509.60
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$294.24
|
| Rate for Payer: United Healthcare All Other HMO |
$286.40
|
| Rate for Payer: United Healthcare HMO Rider |
$280.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.76
|
|
|
HC TLSO MILWAUKEE SUPERSTRUCTURE
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT L1230
|
| Hospital Charge Code |
915351230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Blue Shield of California Commercial |
$628.77
|
| Rate for Payer: Blue Shield of California EPN |
$395.14
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Central Health Plan Commercial |
$627.20
|
| Rate for Payer: Cigna of CA HMO |
$548.80
|
| Rate for Payer: Cigna of CA PPO |
$548.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$705.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: Networks By Design Commercial |
$509.60
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$294.24
|
| Rate for Payer: United Healthcare All Other HMO |
$286.40
|
| Rate for Payer: United Healthcare HMO Rider |
$280.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.76
|
|
|
HC TLSO MILWAUKEE SUPERSTRUCTURE
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT L1230
|
| Hospital Charge Code |
905351230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.13 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Adventist Health Commercial |
$321.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$588.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$456.05
|
| Rate for Payer: Blue Shield of California Commercial |
$628.77
|
| Rate for Payer: Blue Shield of California EPN |
$395.14
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Central Health Plan Commercial |
$627.20
|
| Rate for Payer: Cigna of CA HMO |
$548.80
|
| Rate for Payer: Cigna of CA PPO |
$548.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$666.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$666.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$666.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$705.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$240.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$548.80
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: Networks By Design Commercial |
$392.00
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: Riverside University Health System MISP |
$313.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$470.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$294.24
|
| Rate for Payer: United Healthcare All Other HMO |
$286.40
|
| Rate for Payer: United Healthcare HMO Rider |
$280.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$666.40
|
| Rate for Payer: Vantage Medical Group Senior |
$666.40
|
|
|
HC TLSO MILWAUKEE SUPERSTRUCTURE
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT L1230
|
| Hospital Charge Code |
915351230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.13 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Adventist Health Commercial |
$321.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$588.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$456.05
|
| Rate for Payer: Blue Shield of California Commercial |
$628.77
|
| Rate for Payer: Blue Shield of California EPN |
$395.14
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Central Health Plan Commercial |
$627.20
|
| Rate for Payer: Cigna of CA HMO |
$548.80
|
| Rate for Payer: Cigna of CA PPO |
$548.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$666.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$666.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$666.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$705.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$240.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$548.80
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: Networks By Design Commercial |
$392.00
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: Riverside University Health System MISP |
$313.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$470.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$294.24
|
| Rate for Payer: United Healthcare All Other HMO |
$286.40
|
| Rate for Payer: United Healthcare HMO Rider |
$280.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$666.40
|
| Rate for Payer: Vantage Medical Group Senior |
$666.40
|
|
|
HC TLSO RIB GUSSET
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L1280
|
| Hospital Charge Code |
905351280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Adventist Health Commercial |
$90.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.56
|
| Rate for Payer: Blue Shield of California Commercial |
$177.24
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$154.70
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Riverside University Health System MISP |
$88.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC TLSO RIB GUSSET
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT L1280
|
| Hospital Charge Code |
915351280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Blue Shield of California Commercial |
$177.24
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
|
|
HC TLSO RIB GUSSET
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L1280
|
| Hospital Charge Code |
915351280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Adventist Health Commercial |
$90.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.56
|
| Rate for Payer: Blue Shield of California Commercial |
$177.24
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$154.70
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Riverside University Health System MISP |
$88.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC TLSO RIB GUSSET
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT L1280
|
| Hospital Charge Code |
905351280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Blue Shield of California Commercial |
$177.24
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
|
|
HC TLSO SAGITTAL CNTRL RIGID POST FRAME SFT APRON
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT L0466
|
| Hospital Charge Code |
905350466
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$307.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.27
|
| Rate for Payer: Blue Shield of California Commercial |
$601.50
|
| Rate for Payer: Blue Shield of California EPN |
$378.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$525.00
|
| Rate for Payer: Cigna of CA PPO |
$525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$637.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$515.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$569.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$375.00
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Riverside University Health System MISP |
$300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.48
|
| Rate for Payer: United Healthcare All Other HMO |
$273.98
|
| Rate for Payer: United Healthcare HMO Rider |
$268.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.50
|
| Rate for Payer: Vantage Medical Group Senior |
$637.50
|
|
|
HC TLSO SAGITTAL CNTRL RIGID POST FRAME SFT APRON
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT L0466
|
| Hospital Charge Code |
915350466
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$307.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.27
|
| Rate for Payer: Blue Shield of California Commercial |
$601.50
|
| Rate for Payer: Blue Shield of California EPN |
$378.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$525.00
|
| Rate for Payer: Cigna of CA PPO |
$525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$637.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$515.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$569.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$375.00
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Riverside University Health System MISP |
$300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.48
|
| Rate for Payer: United Healthcare All Other HMO |
$273.98
|
| Rate for Payer: United Healthcare HMO Rider |
$268.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.50
|
| Rate for Payer: Vantage Medical Group Senior |
$637.50
|
|
|
HC TLSO SAGITTAL CNTRL RIGID POST FRAME SFT APRON
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT L0466
|
| Hospital Charge Code |
905350466
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$601.50
|
| Rate for Payer: Blue Shield of California EPN |
$378.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$525.00
|
| Rate for Payer: Cigna of CA PPO |
$525.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.48
|
| Rate for Payer: United Healthcare All Other HMO |
$273.98
|
| Rate for Payer: United Healthcare HMO Rider |
$268.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.62
|
|
|
HC TLSO SAGITTAL CNTRL RIGID POST FRAME SFT APRON
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT L0466
|
| Hospital Charge Code |
915350466
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$601.50
|
| Rate for Payer: Blue Shield of California EPN |
$378.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$525.00
|
| Rate for Payer: Cigna of CA PPO |
$525.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.48
|
| Rate for Payer: United Healthcare All Other HMO |
$273.98
|
| Rate for Payer: United Healthcare HMO Rider |
$268.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.62
|
|
|
HC TLSO SAGITTAL CORONAL CONTROL ONE PIECE
|
Facility
|
OP
|
$2,249.00
|
|
|
Service Code
|
CPT L0490
|
| Hospital Charge Code |
905350490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$305.85 |
| Max. Negotiated Rate |
$2,024.10 |
| Rate for Payer: Adventist Health Commercial |
$922.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,236.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,686.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,308.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,133.50
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,799.20
|
| Rate for Payer: Cigna of CA HMO |
$1,574.30
|
| Rate for Payer: Cigna of CA PPO |
$1,574.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,911.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,911.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,574.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$899.60
|
| Rate for Payer: Galaxy Health WC |
$1,911.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,349.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,024.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$305.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,428.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,326.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,574.30
|
| Rate for Payer: Multiplan Commercial |
$1,686.75
|
| Rate for Payer: Networks By Design Commercial |
$1,124.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,911.65
|
| Rate for Payer: Riverside University Health System MISP |
$899.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,349.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,349.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$844.05
|
| Rate for Payer: United Healthcare All Other HMO |
$821.56
|
| Rate for Payer: United Healthcare HMO Rider |
$803.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,911.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,911.65
|
|
|
HC TLSO SAGITTAL CORONAL CONTROL ONE PIECE
|
Facility
|
IP
|
$2,249.00
|
|
|
Service Code
|
CPT L0490
|
| Hospital Charge Code |
905350490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$2,024.10 |
| Rate for Payer: Adventist Health Commercial |
$449.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,133.50
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,799.20
|
| Rate for Payer: Cigna of CA HMO |
$1,574.30
|
| Rate for Payer: Cigna of CA PPO |
$1,574.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,574.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$899.60
|
| Rate for Payer: Galaxy Health WC |
$1,911.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,349.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,024.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,428.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,326.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.80
|
| Rate for Payer: Multiplan Commercial |
$1,686.75
|
| Rate for Payer: Networks By Design Commercial |
$1,461.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,911.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$844.05
|
| Rate for Payer: United Healthcare All Other HMO |
$821.56
|
| Rate for Payer: United Healthcare HMO Rider |
$803.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.55
|
|
|
HC TLSO SAGITTAL CORONAL CONTROL ONE PIECE
|
Facility
|
OP
|
$2,249.00
|
|
|
Service Code
|
CPT L0490
|
| Hospital Charge Code |
915350490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$305.85 |
| Max. Negotiated Rate |
$2,024.10 |
| Rate for Payer: Adventist Health Commercial |
$922.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,236.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,686.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,308.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,133.50
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,799.20
|
| Rate for Payer: Cigna of CA HMO |
$1,574.30
|
| Rate for Payer: Cigna of CA PPO |
$1,574.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,911.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,911.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,574.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$899.60
|
| Rate for Payer: Galaxy Health WC |
$1,911.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,349.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,024.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$305.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,428.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,326.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,574.30
|
| Rate for Payer: Multiplan Commercial |
$1,686.75
|
| Rate for Payer: Networks By Design Commercial |
$1,124.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,911.65
|
| Rate for Payer: Riverside University Health System MISP |
$899.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,349.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,349.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$844.05
|
| Rate for Payer: United Healthcare All Other HMO |
$821.56
|
| Rate for Payer: United Healthcare HMO Rider |
$803.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,911.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,911.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,911.65
|
|
|
HC TLSO SAGITTAL CORONAL CONTROL ONE PIECE
|
Facility
|
IP
|
$2,249.00
|
|
|
Service Code
|
CPT L0490
|
| Hospital Charge Code |
915350490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$2,024.10 |
| Rate for Payer: Adventist Health Commercial |
$449.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,133.50
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,799.20
|
| Rate for Payer: Cigna of CA HMO |
$1,574.30
|
| Rate for Payer: Cigna of CA PPO |
$1,574.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,574.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$899.60
|
| Rate for Payer: Galaxy Health WC |
$1,911.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,349.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,024.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,428.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,326.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.80
|
| Rate for Payer: Multiplan Commercial |
$1,686.75
|
| Rate for Payer: Networks By Design Commercial |
$1,461.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,911.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$844.05
|
| Rate for Payer: United Healthcare All Other HMO |
$821.56
|
| Rate for Payer: United Healthcare HMO Rider |
$803.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.55
|
|
|
HC TLSO SAGITTAL-CORONAL RIGID POST FRAME SFT APRON
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT L0468
|
| Hospital Charge Code |
915350468
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.70 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$372.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$681.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.77
|
| Rate for Payer: Blue Shield of California Commercial |
$729.02
|
| Rate for Payer: Blue Shield of California EPN |
$458.14
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$772.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$625.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$690.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$636.30
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$454.50
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: Riverside University Health System MISP |
$363.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$545.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$545.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.65
|
| Rate for Payer: Vantage Medical Group Senior |
$772.65
|
|
|
HC TLSO SAGITTAL-CORONAL RIGID POST FRAME SFT APRON
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT L0468
|
| Hospital Charge Code |
905350468
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.70 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$372.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$681.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.77
|
| Rate for Payer: Blue Shield of California Commercial |
$729.02
|
| Rate for Payer: Blue Shield of California EPN |
$458.14
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$772.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$625.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$690.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$636.30
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$454.50
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: Riverside University Health System MISP |
$363.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$545.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$545.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.65
|
| Rate for Payer: Vantage Medical Group Senior |
$772.65
|
|
|
HC TLSO SAGITTAL-CORONAL RIGID POST FRAME SFT APRON
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT L0468
|
| Hospital Charge Code |
915350468
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Blue Shield of California Commercial |
$729.02
|
| Rate for Payer: Blue Shield of California EPN |
$458.14
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$590.85
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
|
|
HC TLSO SAGITTAL-CORONAL RIGID POST FRAME SFT APRON
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT L0468
|
| Hospital Charge Code |
905350468
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Blue Shield of California Commercial |
$729.02
|
| Rate for Payer: Blue Shield of California EPN |
$458.14
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$590.85
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
|
|
HC TLSO SCOLIOSIS PROCEDURE
|
Facility
|
IP
|
$4,062.00
|
|
|
Service Code
|
CPT L1300
|
| Hospital Charge Code |
915351300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$812.40 |
| Max. Negotiated Rate |
$3,655.80 |
| Rate for Payer: Adventist Health Commercial |
$812.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,257.72
|
| Rate for Payer: Blue Shield of California EPN |
$2,047.25
|
| Rate for Payer: Cash Price |
$1,827.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,249.60
|
| Rate for Payer: Cigna of CA HMO |
$2,843.40
|
| Rate for Payer: Cigna of CA PPO |
$2,843.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,843.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.80
|
| Rate for Payer: Galaxy Health WC |
$3,452.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,437.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,655.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,579.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,396.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.40
|
| Rate for Payer: Multiplan Commercial |
$3,046.50
|
| Rate for Payer: Networks By Design Commercial |
$2,640.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,452.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,524.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,483.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,451.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,330.31
|
|
