|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
905350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$339.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.74
|
| Rate for Payer: Blue Distinction Transplant |
$421.20
|
| Rate for Payer: Blue Shield of California Commercial |
$526.50
|
| Rate for Payer: Blue Shield of California EPN |
$381.89
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Media |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.82
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
905350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Blue Shield of California EPN |
$374.87
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$265.08
|
| Rate for Payer: United Healthcare All Other HMO |
$258.90
|
| Rate for Payer: United Healthcare HMO Rider |
$253.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.66
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
905350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$547.05 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$859.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$756.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$923.42
|
| Rate for Payer: Blue Distinction Transplant |
$937.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,172.25
|
| Rate for Payer: Blue Shield of California EPN |
$850.27
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Dignity Health Media |
$1,328.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,328.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,172.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$547.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.83
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: Riverside University Health System MISP |
$625.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$781.50
|
| Rate for Payer: United Healthcare All Other HMO |
$781.50
|
| Rate for Payer: United Healthcare HMO Rider |
$781.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,328.55
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
905350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Blue Shield of California EPN |
$834.64
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.60
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.19
|
| Rate for Payer: United Healthcare All Other HMO |
$576.43
|
| Rate for Payer: United Healthcare HMO Rider |
$563.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$515.79
|
|
|
HC TLSO FULL CORSET
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
905350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$183.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.74
|
| Rate for Payer: Blue Distinction Transplant |
$199.80
|
| Rate for Payer: Blue Shield of California Commercial |
$249.75
|
| Rate for Payer: Blue Shield of California EPN |
$181.15
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.05
|
| Rate for Payer: Dignity Health Media |
$283.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$249.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.53
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$166.50
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: Riverside University Health System MISP |
$133.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.50
|
| Rate for Payer: United Healthcare All Other HMO |
$166.50
|
| Rate for Payer: United Healthcare HMO Rider |
$166.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.05
|
| Rate for Payer: Vantage Medical Group Senior |
$283.05
|
|
|
HC TLSO FULL CORSET
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
905350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Blue Shield of California EPN |
$177.82
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.60
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$166.50
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.74
|
| Rate for Payer: United Healthcare All Other HMO |
$122.81
|
| Rate for Payer: United Healthcare HMO Rider |
$120.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.89
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
IP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
905351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,026.60 |
| Max. Negotiated Rate |
$4,619.70 |
| Rate for Payer: Blue Shield of California EPN |
$2,741.02
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,106.40
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,619.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,423.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,955.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.60
|
| Rate for Payer: Multiplan Commercial |
$3,849.75
|
| Rate for Payer: Networks By Design Commercial |
$2,566.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,938.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1,851.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,693.89
|
|
|
HC TLSO INCLUSIVE FURNISHING ONLY
|
Facility
|
OP
|
$5,133.00
|
|
|
Service Code
|
CPT L1200
|
| Hospital Charge Code |
905351200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,796.55 |
| Max. Negotiated Rate |
$4,619.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,823.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,823.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,485.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,032.58
|
| Rate for Payer: Blue Distinction Transplant |
$3,079.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,849.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,792.35
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,106.40
|
| Rate for Payer: Cigna of CA HMO |
$3,593.10
|
| Rate for Payer: Cigna of CA PPO |
$3,593.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,363.05
|
| Rate for Payer: Dignity Health Media |
$4,363.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,363.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,619.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,849.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,796.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,423.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,351.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,104.53
|
| Rate for Payer: Multiplan Commercial |
$3,849.75
|
| Rate for Payer: Networks By Design Commercial |
$2,566.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,053.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,079.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,079.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,566.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,566.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,566.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,566.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,363.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,363.05
|
|
|
HC TLSO LAT THORACIC EXTENSION
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT L1210
|
| Hospital Charge Code |
905351210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$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: Blue Distinction 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: Dignity Health Media |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$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) Other |
$354.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$165.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.26
|
| 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 System MISP |
$188.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 LAT THORACIC EXTENSION
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT L1210
|
| Hospital Charge Code |
905351210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: 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: Kaiser Permanente of CA Medi-Cal |
$179.83
|
| 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
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.23
|
| Rate for Payer: United Healthcare All Other HMO |
$174.07
|
| Rate for Payer: United Healthcare HMO Rider |
$170.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.76
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
905351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.65 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.39
|
| Rate for Payer: Blue Distinction Transplant |
$131.40
|
| Rate for Payer: Blue Shield of California Commercial |
$164.25
|
| Rate for Payer: Blue Shield of California EPN |
$119.14
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.15
|
| Rate for Payer: Dignity Health Media |
$186.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$164.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.79
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: Riverside University Health System MISP |
$87.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.50
|
| Rate for Payer: United Healthcare All Other HMO |
$109.50
|
| Rate for Payer: United Healthcare HMO Rider |
$109.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
|
HC TLSO LAT TROCHANTERIC PAD
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT L1290
|
| Hospital Charge Code |
905351290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Blue Shield of California EPN |
$116.95
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.80
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.69
|
| Rate for Payer: United Healthcare All Other HMO |
$80.77
|
| Rate for Payer: United Healthcare HMO Rider |
$79.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.27
|
|
|
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: Blue Shield of California EPN |
$70.49
|
| 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: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| 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 |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.84
|
| Rate for Payer: United Healthcare All Other HMO |
$48.68
|
| Rate for Payer: United Healthcare HMO Rider |
$47.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.56
|
|
|
HC TLSO LUMBAR DEROTATION PAD
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L1240
|
| Hospital Charge Code |
905351240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$118.80 |
| 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 |
$72.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.99
|
| Rate for Payer: Blue Distinction Transplant |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$99.00
|
| Rate for Payer: Blue Shield of California EPN |
$71.81
|
| 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 Media |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$99.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| 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 |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC TLSO MILWAUKEE SUPERSTRUCTURE
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT L1230
|
| Hospital Charge Code |
905351230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$265.26 |
| Max. Negotiated Rate |
$705.60 |
| 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 |
$431.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$379.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.19
|
| Rate for Payer: Blue Distinction Transplant |
$470.40
|
| Rate for Payer: Blue Shield of California Commercial |
$588.00
|
| Rate for Payer: Blue Shield of California EPN |
$426.50
|
| 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 Media |
$666.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$588.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$274.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.44
|
| 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 |
$392.00
|
| Rate for Payer: United Healthcare All Other HMO |
$392.00
|
| Rate for Payer: United Healthcare HMO Rider |
$392.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$392.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$666.40
|
| Rate for Payer: Vantage Medical Group Senior |
$666.40
|
|
|
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: Blue Shield of California EPN |
$418.66
|
| 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: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$522.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.70
|
| 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 |
$392.00
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$296.04
|
| Rate for Payer: United Healthcare All Other HMO |
$289.14
|
| Rate for Payer: United Healthcare HMO Rider |
$282.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.72
|
|
|
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: Blue Shield of California EPN |
$118.01
|
| 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: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| 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 |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.45
|
| Rate for Payer: United Healthcare All Other HMO |
$81.50
|
| Rate for Payer: United Healthcare HMO Rider |
$79.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.93
|
|
|
HC TLSO RIB GUSSET
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L1280
|
| Hospital Charge Code |
905351280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$198.90 |
| 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 |
$121.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.57
|
| Rate for Payer: Blue Distinction Transplant |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$165.75
|
| Rate for Payer: Blue Shield of California EPN |
$120.22
|
| 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 Media |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$165.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.61
|
| 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 |
$110.50
|
| Rate for Payer: United Healthcare All Other HMO |
$110.50
|
| Rate for Payer: United Healthcare HMO Rider |
$110.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
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 |
$262.50 |
| Max. Negotiated Rate |
$675.00 |
| 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 |
$412.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$363.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$443.10
|
| Rate for Payer: Blue Distinction Transplant |
$450.00
|
| Rate for Payer: Blue Shield of California Commercial |
$562.50
|
| Rate for Payer: Blue Shield of California EPN |
$408.00
|
| 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 Media |
$637.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$562.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$262.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| 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 |
$375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$375.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$375.00
|
| 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: Blue Shield of California EPN |
$400.50
|
| 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: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.75
|
| 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 |
$375.00
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Other HMO |
$276.60
|
| Rate for Payer: United Healthcare HMO Rider |
$270.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.50
|
|
|
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: Blue Shield of California EPN |
$1,200.97
|
| 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: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,500.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$856.87
|
| 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 |
$1,124.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,911.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$849.22
|
| Rate for Payer: United Healthcare All Other HMO |
$829.43
|
| Rate for Payer: United Healthcare HMO Rider |
$811.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$742.17
|
|
|
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 |
$337.86 |
| Max. Negotiated Rate |
$2,024.10 |
| 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 |
$1,236.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,088.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,328.71
|
| Rate for Payer: Blue Distinction Transplant |
$1,349.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,686.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,223.46
|
| 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 Media |
$1,911.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,911.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,686.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$787.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,500.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.09
|
| 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 |
$1,124.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,124.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,124.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,124.50
|
| 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 RIGID POST FRAME SFT APRON
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT L0468
|
| Hospital Charge Code |
905350468
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$318.15 |
| Max. Negotiated Rate |
$818.10 |
| 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 |
$499.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$440.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$537.04
|
| Rate for Payer: Blue Distinction Transplant |
$545.40
|
| Rate for Payer: Blue Shield of California Commercial |
$681.75
|
| Rate for Payer: Blue Shield of California EPN |
$494.50
|
| 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 Media |
$772.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$681.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.69
|
| 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 |
$454.50
|
| Rate for Payer: United Healthcare All Other HMO |
$454.50
|
| Rate for Payer: United Healthcare HMO Rider |
$454.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$454.50
|
| 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 |
905350468
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Blue Shield of California EPN |
$485.41
|
| 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: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.33
|
| 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 |
$454.50
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$343.24
|
| Rate for Payer: United Healthcare All Other HMO |
$335.24
|
| Rate for Payer: United Healthcare HMO Rider |
$327.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.97
|
|
|
HC TLSO SCOLIOSIS PROCEDURE
|
Facility
|
IP
|
$4,062.00
|
|
|
Service Code
|
CPT L1300
|
| Hospital Charge Code |
905351300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$812.40 |
| Max. Negotiated Rate |
$3,655.80 |
| Rate for Payer: Blue Shield of California EPN |
$2,169.11
|
| 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: EPIC Health Plan Commercial |
$1,624.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,709.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,547.62
|
| 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 |
$2,031.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,452.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,533.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1,498.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,465.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,340.46
|
|
