|
HC TISSUE MARKER 8 GA
|
Facility
OP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$746.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$746.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$345.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$223.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$223.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.70
|
| Rate for Payer: BCBS Transplant Transplant |
$244.20
|
| Rate for Payer: Blue Shield of California Commercial |
$305.25
|
| Rate for Payer: Blue Shield of California EPN |
$221.41
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Central Health Plan Commercial |
$325.60
|
| Rate for Payer: Cigna of CA HMO |
$284.90
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$162.80
|
| Rate for Payer: Galaxy Health WC |
$345.95
|
| Rate for Payer: Global Benefits Group Commercial |
$244.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$366.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$305.25
|
| Rate for Payer: IEHP medi-cal |
$142.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$271.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.40
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: Networks By Design Commercial |
$203.50
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
| Rate for Payer: Riverside University Health MISP |
$162.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.50
|
| Rate for Payer: United Healthcare All Other HMO |
$203.50
|
| Rate for Payer: United Healthcare HMO Rider |
$203.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.95
|
| Rate for Payer: Vantage Medical Group Senior |
$345.95
|
|
|
HC TIXAGEV AND CILGAV INJ
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT M0220
|
| Hospital Charge Code |
911800220
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
|
|
HC TIXAGEV AND CILGAV INJ
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT M0220
|
| Hospital Charge Code |
911800220
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$923.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$197.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$923.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$296.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$217.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$197.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.63
|
| Rate for Payer: BCBS Transplant Transplant |
$258.60
|
| Rate for Payer: Blue Shield of California Commercial |
$271.10
|
| Rate for Payer: Blue Shield of California EPN |
$210.76
|
| Rate for Payer: Caremore Medicare Advantage |
$197.36
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: Cigna of CA HMO |
$275.84
|
| Rate for Payer: Cigna of CA PPO |
$318.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$197.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$197.36
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$323.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$323.67
|
| Rate for Payer: IEHP medi-cal |
$325.64
|
| Rate for Payer: IEHP Medicare Advantage |
$197.36
|
| Rate for Payer: Innovage PACE Commercial |
$296.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.46
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: Prime Health Services Medicare |
$209.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: Riverside University Health MISP |
$217.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.50
|
| Rate for Payer: United Healthcare All Other HMO |
$215.50
|
| Rate for Payer: United Healthcare HMO Rider |
$215.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.10
|
| Rate for Payer: Vantage Medical Group Senior |
$197.36
|
|
|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$467.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$302.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$302.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.15
|
| Rate for Payer: BCBS Transplant Transplant |
$330.00
|
| Rate for Payer: Blue Shield of California Commercial |
$345.95
|
| Rate for Payer: Blue Shield of California EPN |
$268.95
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$385.00
|
| Rate for Payer: Cigna of CA PPO |
$385.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$467.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$412.50
|
| Rate for Payer: IEHP medi-cal |
$192.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$275.00
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: Riverside University Health MISP |
$220.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.00
|
| Rate for Payer: United Healthcare All Other HMO |
$275.00
|
| Rate for Payer: United Healthcare HMO Rider |
$275.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Vantage Medical Group Senior |
$467.50
|
|
|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
IP
|
$550.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Blue Shield of California Commercial |
$412.50
|
| Rate for Payer: Blue Shield of California EPN |
$293.70
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$385.00
|
| Rate for Payer: Cigna of CA PPO |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$275.00
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$938.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.14
|
| Rate for Payer: BCBS Transplant Transplant |
$625.80
|
| Rate for Payer: Blue Shield of California Commercial |
$644.57
|
| Rate for Payer: Blue Shield of California EPN |
$506.90
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$469.35
|
| Rate for Payer: Cash Price |
$469.35
|
| Rate for Payer: Central Health Plan Commercial |
$834.40
|
| Rate for Payer: Cigna of CA HMO |
$667.52
|
| Rate for Payer: Cigna of CA PPO |
$771.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$886.55
|
| Rate for Payer: Global Benefits Group Commercial |
$625.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$938.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$782.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$782.25
|
| Rate for Payer: Networks By Design Commercial |
$677.95
|
| Rate for Payer: Prime Health Services Commercial |
$886.55
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$625.80
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$625.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$625.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$938.70 |
| Rate for Payer: Cash Price |
$469.35
|
| Rate for Payer: Central Health Plan Commercial |
$834.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.20
|
| Rate for Payer: Galaxy Health WC |
$886.55
|
| Rate for Payer: Global Benefits Group Commercial |
$625.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$938.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$782.25
|
| Rate for Payer: Networks By Design Commercial |
$677.95
|
| Rate for Payer: Prime Health Services Commercial |
$886.55
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
IP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
905350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Blue Shield of California EPN |
$774.30
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$725.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
OP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
905350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$507.50 |
| Max. Negotiated Rate |
$3,046.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,046.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$797.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$702.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$856.66
|
| Rate for Payer: BCBS Transplant Transplant |
$870.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,087.50
|
| Rate for Payer: Blue Shield of California EPN |
$788.80
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,232.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,087.50
|
| Rate for Payer: IEHP medi-cal |
$507.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.50
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$725.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: Riverside University Health MISP |
$580.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$725.00
|
| Rate for Payer: United Healthcare HMO Rider |
$725.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$725.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,232.50
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
IP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
905350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Blue Shield of California EPN |
$444.82
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$416.50
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
OP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
905350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.55 |
| Max. Negotiated Rate |
$1,978.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,978.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$458.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$403.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.14
|
| Rate for Payer: BCBS Transplant Transplant |
$499.80
|
| Rate for Payer: Blue Shield of California Commercial |
$624.75
|
| Rate for Payer: Blue Shield of California EPN |
$453.15
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$624.75
|
| Rate for Payer: IEHP medi-cal |
$291.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.53
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$416.50
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Riverside University Health MISP |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other HMO |
$416.50
|
| Rate for Payer: United Healthcare HMO Rider |
$416.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
OP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
905351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$321.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$321.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$102.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.48
|
| Rate for Payer: BCBS Transplant Transplant |
$112.20
|
| Rate for Payer: Blue Shield of California Commercial |
$140.25
|
| Rate for Payer: Blue Shield of California EPN |
$101.73
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$140.25
|
| Rate for Payer: IEHP medi-cal |
$65.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.67
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Riverside University Health MISP |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other HMO |
$93.50
|
| Rate for Payer: United Healthcare HMO Rider |
$93.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
IP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
905351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Blue Shield of California EPN |
$99.86
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.40
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
905351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$299.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$299.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.40
|
| Rate for Payer: BCBS Transplant Transplant |
$65.40
|
| Rate for Payer: Blue Shield of California Commercial |
$81.75
|
| Rate for Payer: Blue Shield of California EPN |
$59.30
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$81.75
|
| Rate for Payer: IEHP medi-cal |
$38.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.69
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$54.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Riverside University Health MISP |
$43.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.50
|
| Rate for Payer: United Healthcare All Other HMO |
$54.50
|
| Rate for Payer: United Healthcare HMO Rider |
$54.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
905351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Blue Shield of California EPN |
$58.21
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$54.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
905351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$314.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$314.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$80.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.85
|
| Rate for Payer: BCBS Transplant Transplant |
$88.20
|
| Rate for Payer: Blue Shield of California Commercial |
$110.25
|
| Rate for Payer: Blue Shield of California EPN |
$79.97
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$110.25
|
| Rate for Payer: IEHP medi-cal |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.27
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health MISP |
$58.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.50
|
| Rate for Payer: United Healthcare HMO Rider |
$73.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
905351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Blue Shield of California EPN |
$78.50
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
|
|
HC TLSO ANT THORACIC EXTENSION
|
Facility
OP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
905351220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$919.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$919.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$259.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$228.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.86
|
| Rate for Payer: BCBS Transplant Transplant |
$283.20
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$256.77
|
| 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: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$354.00
|
| Rate for Payer: IEHP medi-cal |
$165.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.52
|
| 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 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 |
$236.00
|
| Rate for Payer: United Healthcare All Other HMO |
$236.00
|
| Rate for Payer: United Healthcare HMO Rider |
$236.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$236.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC TLSO ANT THORACIC EXTENSION
|
Facility
IP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
905351220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Blue Shield of California EPN |
$252.05
|
| 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: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$314.82
|
| 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 |
$236.00
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
|
|
HC TLSO CORSET FRONT
|
Facility
IP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
905350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Blue Shield of California EPN |
$217.87
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
|
|
HC TLSO CORSET FRONT
|
Facility
OP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
905350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$474.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$474.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$224.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.05
|
| Rate for Payer: BCBS Transplant Transplant |
$244.80
|
| Rate for Payer: Blue Shield of California Commercial |
$306.00
|
| Rate for Payer: Blue Shield of California EPN |
$221.95
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$306.00
|
| Rate for Payer: IEHP medi-cal |
$142.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Riverside University Health MISP |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
IP
|
$662.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
905350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.40 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Blue Shield of California EPN |
$353.51
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Central Health Plan Commercial |
$529.60
|
| Rate for Payer: Cigna of CA HMO |
$463.40
|
| Rate for Payer: Cigna of CA PPO |
$463.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$595.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.40
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
| Rate for Payer: Networks By Design Commercial |
$331.00
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
OP
|
$662.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
905350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$231.70 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$859.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$562.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$364.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$364.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$320.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.11
|
| Rate for Payer: BCBS Transplant Transplant |
$397.20
|
| Rate for Payer: Blue Shield of California Commercial |
$496.50
|
| Rate for Payer: Blue Shield of California EPN |
$360.13
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Central Health Plan Commercial |
$529.60
|
| Rate for Payer: Cigna of CA HMO |
$463.40
|
| Rate for Payer: Cigna of CA PPO |
$463.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$595.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$496.50
|
| Rate for Payer: IEHP medi-cal |
$231.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.42
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
| Rate for Payer: Networks By Design Commercial |
$331.00
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
| Rate for Payer: Riverside University Health MISP |
$264.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.00
|
| Rate for Payer: United Healthcare All Other HMO |
$331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$331.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$562.70
|
| Rate for Payer: Vantage Medical Group Senior |
$562.70
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
IP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
905350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Blue Shield of California EPN |
$186.37
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Central Health Plan Commercial |
$279.20
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.80
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: Networks By Design Commercial |
$174.50
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
OP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
905350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.15 |
| Max. Negotiated Rate |
$721.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$721.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$191.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$191.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.19
|
| Rate for Payer: BCBS Transplant Transplant |
$209.40
|
| Rate for Payer: Blue Shield of California Commercial |
$261.75
|
| Rate for Payer: Blue Shield of California EPN |
$189.86
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Central Health Plan Commercial |
$279.20
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$261.75
|
| Rate for Payer: IEHP medi-cal |
$122.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.09
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: Networks By Design Commercial |
$174.50
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: Riverside University Health MISP |
$139.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.50
|
| Rate for Payer: United Healthcare All Other HMO |
$174.50
|
| Rate for Payer: United Healthcare HMO Rider |
$174.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.65
|
| Rate for Payer: Vantage Medical Group Senior |
$296.65
|
|
