|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Blue Shield of California Commercial |
$425.15
|
| Rate for Payer: Blue Shield of California EPN |
$277.20
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$385.00
|
| Rate for Payer: Cigna of CA PPO |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$340.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$275.00
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.41
|
| Rate for Payer: United Healthcare All Other HMO |
$200.91
|
| Rate for Payer: United Healthcare HMO Rider |
$196.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.12
|
|
|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$302.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$412.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.01
|
| Rate for Payer: Blue Shield of California Commercial |
$336.05
|
| Rate for Payer: Blue Shield of California EPN |
$219.45
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$385.00
|
| Rate for Payer: Cigna of CA PPO |
$385.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$467.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$467.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.72
|
| Rate for Payer: InnovAge PACE Commercial |
$275.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$340.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.00
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$275.00
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: Riverside University Health System MISP |
$220.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.41
|
| Rate for Payer: United Healthcare All Other HMO |
$200.91
|
| Rate for Payer: United Healthcare HMO Rider |
$196.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$467.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Vantage Medical Group Senior |
$467.50
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$703.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.31
|
| Rate for Payer: Blue Shield of California Commercial |
$702.91
|
| Rate for Payer: Blue Shield of California EPN |
$459.73
|
| Rate for Payer: Cash Price |
$636.90
|
| Rate for Payer: Cash Price |
$636.90
|
| Rate for Payer: Central Health Plan Commercial |
$926.40
|
| Rate for Payer: Cigna of CA HMO |
$741.12
|
| Rate for Payer: Cigna of CA PPO |
$856.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,042.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$868.50
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$694.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Cash Price |
$636.90
|
| Rate for Payer: Central Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.20
|
| Rate for Payer: EPIC Health Plan Senior |
$463.20
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,042.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$716.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.60
|
| Rate for Payer: Multiplan Commercial |
$868.50
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
915350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$474.88 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Adventist Health Commercial |
$594.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,087.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$851.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,120.85
|
| Rate for Payer: Blue Shield of California EPN |
$730.80
|
| Rate for Payer: Cash Price |
$797.50
|
| Rate for Payer: Cash Price |
$797.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,232.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,232.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$830.38
|
| Rate for Payer: InnovAge PACE Commercial |
$725.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$897.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,015.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$725.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: Riverside University Health System MISP |
$580.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,232.50
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
905350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Adventist Health Commercial |
$290.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,120.85
|
| Rate for Payer: Blue Shield of California EPN |
$730.80
|
| Rate for Payer: Cash Price |
$797.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$897.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$942.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
905350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$474.88 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Adventist Health Commercial |
$594.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,087.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$851.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,120.85
|
| Rate for Payer: Blue Shield of California EPN |
$730.80
|
| Rate for Payer: Cash Price |
$797.50
|
| Rate for Payer: Cash Price |
$797.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,232.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,232.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$830.38
|
| Rate for Payer: InnovAge PACE Commercial |
$725.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$897.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,015.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$725.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: Riverside University Health System MISP |
$580.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,232.50
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
915350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Adventist Health Commercial |
$290.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,120.85
|
| Rate for Payer: Blue Shield of California EPN |
$730.80
|
| Rate for Payer: Cash Price |
$797.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$897.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$942.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
915350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$272.81 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$341.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.22
|
| Rate for Payer: Blue Shield of California Commercial |
$643.91
|
| Rate for Payer: Blue Shield of California EPN |
$419.83
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$573.00
|
| Rate for Payer: InnovAge PACE Commercial |
$416.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$583.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$583.10
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$416.50
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Riverside University Health System MISP |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.62
|
| Rate for Payer: United Healthcare All Other HMO |
$304.29
|
| Rate for Payer: United Healthcare HMO Rider |
$297.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
915350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Blue Shield of California Commercial |
$643.91
|
| Rate for Payer: Blue Shield of California EPN |
$419.83
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.62
|
| Rate for Payer: United Healthcare All Other HMO |
$304.29
|
| Rate for Payer: United Healthcare HMO Rider |
$297.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.81
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
905350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$272.81 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$341.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.22
|
| Rate for Payer: Blue Shield of California Commercial |
$643.91
|
| Rate for Payer: Blue Shield of California EPN |
$419.83
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$573.00
|
| Rate for Payer: InnovAge PACE Commercial |
$416.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$583.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$583.10
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$416.50
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Riverside University Health System MISP |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.62
|
| Rate for Payer: United Healthcare All Other HMO |
$304.29
|
| Rate for Payer: United Healthcare HMO Rider |
$297.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
905350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Blue Shield of California Commercial |
$643.91
|
| Rate for Payer: Blue Shield of California EPN |
$419.83
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.62
|
| Rate for Payer: United Healthcare All Other HMO |
$304.29
|
| Rate for Payer: United Healthcare HMO Rider |
$297.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.81
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
915351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Blue Shield of California Commercial |
$144.55
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.40
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
905351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.24 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.83
|
| Rate for Payer: Blue Shield of California Commercial |
$144.55
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.37
|
| Rate for Payer: InnovAge PACE Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Riverside University Health System MISP |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
905351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Blue Shield of California Commercial |
$144.55
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.40
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
915351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.24 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.83
|
| Rate for Payer: Blue Shield of California Commercial |
$144.55
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.37
|
| Rate for Payer: InnovAge PACE Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Riverside University Health System MISP |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
905351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$44.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.02
|
| Rate for Payer: Blue Shield of California Commercial |
$84.26
|
| Rate for Payer: Blue Shield of California EPN |
$54.94
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.46
|
| Rate for Payer: InnovAge PACE Commercial |
$54.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$54.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Riverside University Health System MISP |
$43.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.91
|
| Rate for Payer: United Healthcare All Other HMO |
$39.82
|
| Rate for Payer: United Healthcare HMO Rider |
$38.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
905351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Blue Shield of California Commercial |
$84.26
|
| Rate for Payer: Blue Shield of California EPN |
$54.94
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.91
|
| Rate for Payer: United Healthcare All Other HMO |
$39.82
|
| Rate for Payer: United Healthcare HMO Rider |
$38.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.70
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
915351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$44.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.02
|
| Rate for Payer: Blue Shield of California Commercial |
$84.26
|
| Rate for Payer: Blue Shield of California EPN |
$54.94
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.46
|
| Rate for Payer: InnovAge PACE Commercial |
$54.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$54.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Riverside University Health System MISP |
$43.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.91
|
| Rate for Payer: United Healthcare All Other HMO |
$39.82
|
| Rate for Payer: United Healthcare HMO Rider |
$38.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC TLSO ANT ASIS PAD
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT L1250
|
| Hospital Charge Code |
915351250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Blue Shield of California Commercial |
$84.26
|
| Rate for Payer: Blue Shield of California EPN |
$54.94
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Cigna of CA HMO |
$76.30
|
| Rate for Payer: Cigna of CA PPO |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.91
|
| Rate for Payer: United Healthcare All Other HMO |
$39.82
|
| Rate for Payer: United Healthcare HMO Rider |
$38.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.70
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
905351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
915351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.33
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.17
|
| Rate for Payer: InnovAge PACE Commercial |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health System MISP |
$58.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
905351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.33
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.17
|
| Rate for Payer: InnovAge PACE Commercial |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health System MISP |
$58.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC TLSO ANT THORACIC DEROTATION P
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L1260
|
| Hospital Charge Code |
915351260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC TLSO ANT THORACIC EXTENSION
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
915351220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.58 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$193.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.21
|
| Rate for Payer: Blue Shield of California Commercial |
$364.86
|
| Rate for Payer: Blue Shield of California EPN |
$237.89
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$240.13
|
| Rate for Payer: InnovAge PACE Commercial |
$236.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$292.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$236.00
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: Riverside University Health System MISP |
$188.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.14
|
| Rate for Payer: United Healthcare All Other HMO |
$172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$168.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
