|
HC TLSO SCOLIOSIS PROCEDURE
|
Facility
|
OP
|
$4,062.00
|
|
|
Service Code
|
CPT L1300
|
| Hospital Charge Code |
905351300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,421.70 |
| Max. Negotiated Rate |
$3,655.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,452.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,234.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,234.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,966.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,399.83
|
| Rate for Payer: Blue Distinction Transplant |
$2,437.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,046.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,209.73
|
| Rate for Payer: Cash Price |
$1,827.90
|
| 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: Dignity Health Commercial/Exchange |
$3,452.70
|
| Rate for Payer: Dignity Health Media |
$3,452.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,452.70
|
| 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: Health Plan of Nevada (Sierra) Other |
$3,046.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,421.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,709.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,665.42
|
| 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: Riverside University Health System MISP |
$1,624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,437.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,437.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,031.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,031.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,031.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,031.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,452.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,452.70
|
|
|
HC TLSO SCOLI POST OPERATIVE
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
CPT L1310
|
| Hospital Charge Code |
905351310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$1,422.00 |
| Rate for Payer: Blue Shield of California EPN |
$843.72
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,264.00
|
| Rate for Payer: Cigna of CA HMO |
$1,106.00
|
| Rate for Payer: Cigna of CA PPO |
$1,106.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$632.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$632.00
|
| Rate for Payer: Galaxy Health WC |
$1,343.00
|
| Rate for Payer: Global Benefits Group Commercial |
$948.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,422.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,053.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.00
|
| Rate for Payer: Multiplan Commercial |
$1,185.00
|
| Rate for Payer: Networks By Design Commercial |
$790.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,343.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$596.61
|
| Rate for Payer: United Healthcare All Other HMO |
$582.70
|
| Rate for Payer: United Healthcare HMO Rider |
$570.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$521.40
|
|
|
HC TLSO SCOLI POST OPERATIVE
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
CPT L1310
|
| Hospital Charge Code |
905351310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$553.00 |
| Max. Negotiated Rate |
$1,541.74 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$869.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$869.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$765.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$933.46
|
| Rate for Payer: Blue Distinction Transplant |
$948.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,185.00
|
| Rate for Payer: Blue Shield of California EPN |
$859.52
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,264.00
|
| Rate for Payer: Cigna of CA HMO |
$1,106.00
|
| Rate for Payer: Cigna of CA PPO |
$1,106.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,343.00
|
| Rate for Payer: Dignity Health Media |
$1,343.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$632.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$632.00
|
| Rate for Payer: Galaxy Health WC |
$1,343.00
|
| Rate for Payer: Global Benefits Group Commercial |
$948.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,422.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,185.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$553.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,053.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,541.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.80
|
| Rate for Payer: Multiplan Commercial |
$1,185.00
|
| Rate for Payer: Networks By Design Commercial |
$790.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,343.00
|
| Rate for Payer: Riverside University Health System MISP |
$632.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$948.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$948.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$790.00
|
| Rate for Payer: United Healthcare All Other HMO |
$790.00
|
| Rate for Payer: United Healthcare HMO Rider |
$790.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$790.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,343.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,343.00
|
|
|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
OP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
905350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,094.10 |
| Max. Negotiated Rate |
$2,813.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,719.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,719.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,513.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,846.84
|
| Rate for Payer: Blue Distinction Transplant |
$1,875.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,344.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,700.54
|
| Rate for Payer: Cash Price |
$1,406.70
|
| Rate for Payer: Cash Price |
$1,406.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,500.80
|
| Rate for Payer: Cigna of CA HMO |
$2,188.20
|
| Rate for Payer: Cigna of CA PPO |
$2,188.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Dignity Health Media |
$2,657.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,657.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,250.40
|
| Rate for Payer: Galaxy Health WC |
$2,657.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,813.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,344.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,094.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.66
|
| Rate for Payer: Multiplan Commercial |
$2,344.50
|
| Rate for Payer: Networks By Design Commercial |
$1,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.10
|
| Rate for Payer: Riverside University Health System MISP |
$1,250.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,875.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,875.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,563.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,563.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,563.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,563.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,657.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,657.10
|
|
|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
IP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
905350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$625.20 |
| Max. Negotiated Rate |
$2,813.40 |
| Rate for Payer: Blue Shield of California EPN |
$1,669.28
|
| Rate for Payer: Cash Price |
$1,406.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,500.80
|
| Rate for Payer: Cigna of CA HMO |
$2,188.20
|
| Rate for Payer: Cigna of CA PPO |
$2,188.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,250.40
|
| Rate for Payer: Galaxy Health WC |
$2,657.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,813.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,191.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.20
|
| Rate for Payer: Multiplan Commercial |
$2,344.50
|
| Rate for Payer: Networks By Design Commercial |
$1,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,180.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,152.87
|
| Rate for Payer: United Healthcare HMO Rider |
$1,127.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,031.58
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
905350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$2,192.40 |
| Rate for Payer: Blue Shield of California EPN |
$1,300.82
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,948.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,192.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.20
|
| Rate for Payer: Multiplan Commercial |
$1,827.00
|
| Rate for Payer: Networks By Design Commercial |
$1,218.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.83
|
| Rate for Payer: United Healthcare All Other HMO |
$898.40
|
| Rate for Payer: United Healthcare HMO Rider |
$878.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$803.88
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
905350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$852.60 |
| Max. Negotiated Rate |
$2,192.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,339.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,339.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,179.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,439.19
|
| Rate for Payer: Blue Distinction Transplant |
$1,461.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,827.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,325.18
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,948.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Dignity Health Media |
$2,070.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,192.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,827.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$852.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,851.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.76
|
| Rate for Payer: Multiplan Commercial |
$1,827.00
|
| Rate for Payer: Networks By Design Commercial |
$1,218.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: Riverside University Health System MISP |
$974.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,461.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,461.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,218.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,218.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,218.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,218.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,070.60
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
905350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$478.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$421.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.00
|
| Rate for Payer: Blue Distinction Transplant |
$522.00
|
| Rate for Payer: Blue Shield of California Commercial |
$652.50
|
| Rate for Payer: Blue Shield of California EPN |
$473.28
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Central Health Plan Commercial |
$696.00
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$739.50
|
| Rate for Payer: Dignity Health Media |
$739.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$652.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.70
|
| Rate for Payer: Multiplan Commercial |
$652.50
|
| Rate for Payer: Networks By Design Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Riverside University Health System MISP |
$348.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO |
$435.00
|
| Rate for Payer: United Healthcare HMO Rider |
$435.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$435.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$739.50
|
| Rate for Payer: Vantage Medical Group Senior |
$739.50
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
905350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Blue Shield of California EPN |
$464.58
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Central Health Plan Commercial |
$696.00
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.00
|
| Rate for Payer: Multiplan Commercial |
$652.50
|
| Rate for Payer: Networks By Design Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.51
|
| Rate for Payer: United Healthcare All Other HMO |
$320.86
|
| Rate for Payer: United Healthcare HMO Rider |
$313.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.10
|
|
|
HC TLSO TRIPLANAR CNTRL LINER 2 P
|
Facility
|
IP
|
$3,626.00
|
|
|
Service Code
|
CPT L0486
|
| Hospital Charge Code |
905350486
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$725.20 |
| Max. Negotiated Rate |
$3,263.40 |
| Rate for Payer: Blue Shield of California EPN |
$1,936.28
|
| Rate for Payer: Cash Price |
$1,631.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,900.80
|
| Rate for Payer: Cigna of CA HMO |
$2,538.20
|
| Rate for Payer: Cigna of CA PPO |
$2,538.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,450.40
|
| Rate for Payer: Galaxy Health WC |
$3,082.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,175.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,263.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,418.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.20
|
| Rate for Payer: Multiplan Commercial |
$2,719.50
|
| Rate for Payer: Networks By Design Commercial |
$1,813.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,369.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1,337.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,308.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,196.58
|
|
|
HC TLSO TRIPLANAR CNTRL LINER 2 P
|
Facility
|
OP
|
$3,626.00
|
|
|
Service Code
|
CPT L0486
|
| Hospital Charge Code |
905350486
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,269.10 |
| Max. Negotiated Rate |
$3,263.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,994.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,994.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,755.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,142.24
|
| Rate for Payer: Blue Distinction Transplant |
$2,175.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,719.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,972.54
|
| Rate for Payer: Cash Price |
$1,631.70
|
| Rate for Payer: Cash Price |
$1,631.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,900.80
|
| Rate for Payer: Cigna of CA HMO |
$2,538.20
|
| Rate for Payer: Cigna of CA PPO |
$2,538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Dignity Health Media |
$3,082.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,082.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,450.40
|
| Rate for Payer: Galaxy Health WC |
$3,082.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,175.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,263.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,719.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,269.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,418.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.66
|
| Rate for Payer: Multiplan Commercial |
$2,719.50
|
| Rate for Payer: Networks By Design Commercial |
$1,813.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.10
|
| Rate for Payer: Riverside University Health System MISP |
$1,450.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,175.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,175.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,813.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,813.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,082.10
|
|
|
HC TLSO TRIPLANAR CNTRL LINER ANT
|
Facility
|
IP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
905350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.60 |
| Max. Negotiated Rate |
$2,500.20 |
| Rate for Payer: Blue Shield of California EPN |
$1,483.45
|
| Rate for Payer: Cash Price |
$1,250.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,222.40
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,500.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,058.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.60
|
| Rate for Payer: Multiplan Commercial |
$2,083.50
|
| Rate for Payer: Networks By Design Commercial |
$1,389.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,048.97
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,002.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$916.74
|
|
|
HC TLSO TRIPLANAR CNTRL LINER ANT
|
Facility
|
OP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
905350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$972.30 |
| Max. Negotiated Rate |
$2,500.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,527.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,527.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,345.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,641.24
|
| Rate for Payer: Blue Distinction Transplant |
$1,666.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,083.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,511.23
|
| Rate for Payer: Cash Price |
$1,250.10
|
| Rate for Payer: Cash Price |
$1,250.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,222.40
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Dignity Health Media |
$2,361.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,361.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,500.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,083.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$972.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,110.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,138.98
|
| Rate for Payer: Multiplan Commercial |
$2,083.50
|
| Rate for Payer: Networks By Design Commercial |
$1,389.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,111.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,666.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,666.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,389.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,389.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,389.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,361.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,361.30
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
905350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$479.85 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$754.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$754.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$663.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$809.99
|
| Rate for Payer: Blue Distinction Transplant |
$822.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,028.25
|
| Rate for Payer: Blue Shield of California EPN |
$745.82
|
| Rate for Payer: Cash Price |
$616.95
|
| Rate for Payer: Cash Price |
$616.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.80
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Dignity Health Media |
$1,165.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,165.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,028.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$479.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$972.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.11
|
| Rate for Payer: Multiplan Commercial |
$1,028.25
|
| Rate for Payer: Networks By Design Commercial |
$685.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: Riverside University Health System MISP |
$548.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$685.50
|
| Rate for Payer: United Healthcare All Other HMO |
$685.50
|
| Rate for Payer: United Healthcare HMO Rider |
$685.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$685.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,165.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,165.35
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
905350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.20 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Blue Shield of California EPN |
$732.11
|
| Rate for Payer: Cash Price |
$616.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.80
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.20
|
| Rate for Payer: Multiplan Commercial |
$1,028.25
|
| Rate for Payer: Networks By Design Commercial |
$685.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.69
|
| Rate for Payer: United Healthcare All Other HMO |
$505.62
|
| Rate for Payer: United Healthcare HMO Rider |
$494.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.43
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
905350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$382.90 |
| Max. Negotiated Rate |
$1,491.23 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$601.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$529.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.34
|
| Rate for Payer: Blue Distinction Transplant |
$656.40
|
| Rate for Payer: Blue Shield of California Commercial |
$820.50
|
| Rate for Payer: Blue Shield of California EPN |
$595.14
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Media |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$820.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$382.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,491.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.54
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Riverside University Health System MISP |
$437.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.00
|
| Rate for Payer: United Healthcare All Other HMO |
$547.00
|
| Rate for Payer: United Healthcare HMO Rider |
$547.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
905350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$984.60 |
| Rate for Payer: Blue Shield of California EPN |
$584.20
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.09
|
| Rate for Payer: United Healthcare All Other HMO |
$403.47
|
| Rate for Payer: United Healthcare HMO Rider |
$394.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.02
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
905350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$2,251.80 |
| Rate for Payer: Blue Shield of California EPN |
$1,336.07
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,001.60
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,251.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$953.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.40
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Networks By Design Commercial |
$1,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$944.76
|
| Rate for Payer: United Healthcare All Other HMO |
$922.74
|
| Rate for Payer: United Healthcare HMO Rider |
$902.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$825.66
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
905350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$875.70 |
| Max. Negotiated Rate |
$2,251.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,376.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,376.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,211.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,478.18
|
| Rate for Payer: Blue Distinction Transplant |
$1,501.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,876.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,361.09
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,001.60
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Dignity Health Media |
$2,126.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,251.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,876.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$875.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,775.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.82
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Networks By Design Commercial |
$1,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,000.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,501.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,251.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,251.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,251.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,251.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,126.70
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
905350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$591.50 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$929.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$929.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$818.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$998.45
|
| Rate for Payer: Blue Distinction Transplant |
$1,014.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.50
|
| Rate for Payer: Blue Shield of California EPN |
$919.36
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Dignity Health Media |
$1,436.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,267.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$591.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,198.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$692.90
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$845.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: Riverside University Health System MISP |
$676.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$845.00
|
| Rate for Payer: United Healthcare All Other HMO |
$845.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$845.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,436.50
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
905350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Blue Shield of California EPN |
$902.46
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$845.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$638.14
|
| Rate for Payer: United Healthcare All Other HMO |
$623.27
|
| Rate for Payer: United Healthcare HMO Rider |
$609.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$557.70
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
905350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$382.90 |
| Max. Negotiated Rate |
$1,065.18 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$601.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$529.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.34
|
| Rate for Payer: Blue Distinction Transplant |
$656.40
|
| Rate for Payer: Blue Shield of California Commercial |
$820.50
|
| Rate for Payer: Blue Shield of California EPN |
$595.14
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Media |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$820.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$382.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.54
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Riverside University Health System MISP |
$437.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.00
|
| Rate for Payer: United Healthcare All Other HMO |
$547.00
|
| Rate for Payer: United Healthcare HMO Rider |
$547.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
905350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$984.60 |
| Rate for Payer: Blue Shield of California EPN |
$584.20
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.09
|
| Rate for Payer: United Healthcare All Other HMO |
$403.47
|
| Rate for Payer: United Healthcare HMO Rider |
$394.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.02
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
905350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$848.75 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,333.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,333.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,174.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,432.69
|
| Rate for Payer: Blue Distinction Transplant |
$1,455.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,818.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,319.20
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.00
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Dignity Health Media |
$2,061.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,061.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,182.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,818.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$848.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,617.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,198.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.25
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Networks By Design Commercial |
$1,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: Riverside University Health System MISP |
$970.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,212.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,212.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,212.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,061.25
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
905350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Blue Shield of California EPN |
$1,294.95
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.00
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,182.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,617.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Networks By Design Commercial |
$1,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$915.68
|
| Rate for Payer: United Healthcare All Other HMO |
$894.34
|
| Rate for Payer: United Healthcare HMO Rider |
$874.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$800.25
|
|
