|
HC TLSO ANT THORACIC EXTENSION
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
905351220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| 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: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan 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: Kaiser Permanente of CA Commercial/Self Funded |
$314.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| 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
|
|
|
HC TLSO ANT THORACIC EXTENSION
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
915351220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| 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: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$330.40
|
| Rate for Payer: Cigna of CA PPO |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan 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: Kaiser Permanente of CA Commercial/Self Funded |
$314.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| 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
|
|
|
HC TLSO ANT THORACIC EXTENSION
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT L1220
|
| Hospital Charge Code |
905351220
|
|
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
|
|
|
HC TLSO CORSET FRONT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
905350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$167.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.62
|
| Rate for Payer: Blue Shield of California Commercial |
$315.38
|
| Rate for Payer: Blue Shield of California EPN |
$205.63
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.71
|
| Rate for Payer: InnovAge PACE Commercial |
$204.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Riverside University Health System MISP |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC TLSO CORSET FRONT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
915350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$167.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.62
|
| Rate for Payer: Blue Shield of California Commercial |
$315.38
|
| Rate for Payer: Blue Shield of California EPN |
$205.63
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.71
|
| Rate for Payer: InnovAge PACE Commercial |
$204.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Riverside University Health System MISP |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC TLSO CORSET FRONT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
915350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Blue Shield of California Commercial |
$315.38
|
| Rate for Payer: Blue Shield of California EPN |
$205.63
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
|
|
HC TLSO CORSET FRONT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT L0970
|
| Hospital Charge Code |
905350970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Blue Shield of California Commercial |
$315.38
|
| Rate for Payer: Blue Shield of California EPN |
$205.63
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
905350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.40 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Adventist Health Commercial |
$132.40
|
| Rate for Payer: Blue Shield of California Commercial |
$511.73
|
| Rate for Payer: Blue Shield of California EPN |
$333.65
|
| Rate for Payer: Cash Price |
$364.10
|
| Rate for Payer: Central Health Plan Commercial |
$529.60
|
| Rate for Payer: Cigna of CA HMO |
$463.40
|
| Rate for Payer: Cigna of CA PPO |
$463.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Senior |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$595.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$409.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.40
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
| Rate for Payer: Networks By Design Commercial |
$430.30
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.45
|
| Rate for Payer: United Healthcare All Other HMO |
$241.83
|
| Rate for Payer: United Healthcare HMO Rider |
$236.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.81
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
915350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$247.26 |
| Max. Negotiated Rate |
$679.50 |
| Rate for Payer: Adventist Health Commercial |
$309.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$641.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$415.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$566.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$443.41
|
| Rate for Payer: Blue Shield of California Commercial |
$583.62
|
| Rate for Payer: Blue Shield of California EPN |
$380.52
|
| Rate for Payer: Cash Price |
$415.25
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: Cigna of CA HMO |
$528.50
|
| Rate for Payer: Cigna of CA PPO |
$528.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$641.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$641.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$641.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: EPIC Health Plan Senior |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: InnovAge PACE Commercial |
$377.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$528.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$528.50
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Networks By Design Commercial |
$377.50
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: Riverside University Health System MISP |
$302.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.35
|
| Rate for Payer: United Healthcare All Other HMO |
$275.80
|
| Rate for Payer: United Healthcare HMO Rider |
$269.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$641.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$641.75
|
| Rate for Payer: Vantage Medical Group Senior |
$641.75
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
915350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$679.50 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Blue Shield of California Commercial |
$583.62
|
| Rate for Payer: Blue Shield of California EPN |
$380.52
|
| Rate for Payer: Cash Price |
$415.25
|
| Rate for Payer: Central Health Plan Commercial |
$604.00
|
| Rate for Payer: Cigna of CA HMO |
$528.50
|
| Rate for Payer: Cigna of CA PPO |
$528.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: EPIC Health Plan Senior |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$679.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.35
|
| Rate for Payer: United Healthcare All Other HMO |
$275.80
|
| Rate for Payer: United Healthcare HMO Rider |
$269.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.26
|
|
|
HC TLSO FLEX INC SHLDR STRAP CUSTOM
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
CPT L0452
|
| Hospital Charge Code |
905350452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$216.81 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Adventist Health Commercial |
$271.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$496.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.79
|
| Rate for Payer: Blue Shield of California Commercial |
$511.73
|
| Rate for Payer: Blue Shield of California EPN |
$333.65
|
| Rate for Payer: Cash Price |
$364.10
|
| Rate for Payer: Central Health Plan Commercial |
$529.60
|
| Rate for Payer: Cigna of CA HMO |
$463.40
|
| Rate for Payer: Cigna of CA PPO |
$463.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$562.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$562.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Senior |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$595.80
|
| Rate for Payer: InnovAge PACE Commercial |
$331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$409.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$463.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$463.40
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
| Rate for Payer: Networks By Design Commercial |
$331.00
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
| Rate for Payer: Riverside University Health System MISP |
$264.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.45
|
| Rate for Payer: United Healthcare All Other HMO |
$241.83
|
| Rate for Payer: United Healthcare HMO Rider |
$236.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$562.70
|
| Rate for Payer: Vantage Medical Group Senior |
$562.70
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
905350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Blue Shield of California Commercial |
$269.78
|
| Rate for Payer: Blue Shield of California EPN |
$175.90
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Central Health Plan Commercial |
$279.20
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.80
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: Networks By Design Commercial |
$226.85
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.98
|
| Rate for Payer: United Healthcare All Other HMO |
$127.49
|
| Rate for Payer: United Healthcare HMO Rider |
$124.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.30
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
915350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.30 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Adventist Health Commercial |
$143.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.97
|
| Rate for Payer: Blue Shield of California Commercial |
$269.78
|
| Rate for Payer: Blue Shield of California EPN |
$175.90
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Central Health Plan Commercial |
$279.20
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$296.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$296.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$240.03
|
| Rate for Payer: InnovAge PACE Commercial |
$174.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.30
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: Networks By Design Commercial |
$174.50
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: Riverside University Health System MISP |
$139.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.98
|
| Rate for Payer: United Healthcare All Other HMO |
$127.49
|
| Rate for Payer: United Healthcare HMO Rider |
$124.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.65
|
| Rate for Payer: Vantage Medical Group Senior |
$296.65
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
915350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Blue Shield of California Commercial |
$269.78
|
| Rate for Payer: Blue Shield of California EPN |
$175.90
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Central Health Plan Commercial |
$279.20
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.80
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: Networks By Design Commercial |
$226.85
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.98
|
| Rate for Payer: United Healthcare All Other HMO |
$127.49
|
| Rate for Payer: United Healthcare HMO Rider |
$124.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.30
|
|
|
HC TLSO FLEX INC SHLDR STRAP PREFABRICATED
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT L0450
|
| Hospital Charge Code |
905350450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.30 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Adventist Health Commercial |
$143.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.97
|
| Rate for Payer: Blue Shield of California Commercial |
$269.78
|
| Rate for Payer: Blue Shield of California EPN |
$175.90
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Central Health Plan Commercial |
$279.20
|
| Rate for Payer: Cigna of CA HMO |
$244.30
|
| Rate for Payer: Cigna of CA PPO |
$244.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$296.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$296.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$240.03
|
| Rate for Payer: InnovAge PACE Commercial |
$174.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.30
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: Networks By Design Commercial |
$174.50
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: Riverside University Health System MISP |
$139.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.98
|
| Rate for Payer: United Healthcare All Other HMO |
$127.49
|
| Rate for Payer: United Healthcare HMO Rider |
$124.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.65
|
| Rate for Payer: Vantage Medical Group Senior |
$296.65
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
915350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.91 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$287.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.28
|
| Rate for Payer: Blue Shield of California Commercial |
$542.65
|
| Rate for Payer: Blue Shield of California EPN |
$353.81
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$374.99
|
| Rate for Payer: InnovAge PACE Commercial |
$351.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
915350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Blue Shield of California Commercial |
$542.65
|
| Rate for Payer: Blue Shield of California EPN |
$353.81
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
905350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.91 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$287.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.28
|
| Rate for Payer: Blue Shield of California Commercial |
$542.65
|
| Rate for Payer: Blue Shield of California EPN |
$353.81
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$374.99
|
| Rate for Payer: InnovAge PACE Commercial |
$351.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC TLSO FLEX S1 TO T9 PREFAB
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT L0454
|
| Hospital Charge Code |
905350454
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Blue Shield of California Commercial |
$542.65
|
| Rate for Payer: Blue Shield of California EPN |
$353.81
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
905350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.88 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Adventist Health Commercial |
$640.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,172.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$917.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,208.20
|
| Rate for Payer: Blue Shield of California EPN |
$787.75
|
| Rate for Payer: Cash Price |
$859.65
|
| Rate for Payer: Cash Price |
$859.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,328.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,328.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,075.36
|
| Rate for Payer: InnovAge PACE Commercial |
$781.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$967.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,094.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,094.10
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: Riverside University Health System MISP |
$625.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,328.55
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
905350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Adventist Health Commercial |
$312.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,208.20
|
| Rate for Payer: Blue Shield of California EPN |
$787.75
|
| Rate for Payer: Cash Price |
$859.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$967.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.60
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$1,015.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
915350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Adventist Health Commercial |
$312.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,208.20
|
| Rate for Payer: Blue Shield of California EPN |
$787.75
|
| Rate for Payer: Cash Price |
$859.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$967.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.60
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$1,015.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
|
|
HC TLSO FLEX SOFT ANT APRON PREFA
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
915350456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.88 |
| Max. Negotiated Rate |
$1,406.70 |
| Rate for Payer: Adventist Health Commercial |
$640.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,172.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$917.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,208.20
|
| Rate for Payer: Blue Shield of California EPN |
$787.75
|
| Rate for Payer: Cash Price |
$859.65
|
| Rate for Payer: Cash Price |
$859.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,250.40
|
| Rate for Payer: Cigna of CA HMO |
$1,094.10
|
| Rate for Payer: Cigna of CA PPO |
$1,094.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,328.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,328.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.20
|
| Rate for Payer: EPIC Health Plan Senior |
$625.20
|
| Rate for Payer: Galaxy Health WC |
$1,328.55
|
| Rate for Payer: Global Benefits Group Commercial |
$937.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,406.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,075.36
|
| Rate for Payer: InnovAge PACE Commercial |
$781.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,042.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$967.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,094.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,094.10
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
| Rate for Payer: Networks By Design Commercial |
$781.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,328.55
|
| Rate for Payer: Riverside University Health System MISP |
$625.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.59
|
| Rate for Payer: United Healthcare All Other HMO |
$570.96
|
| Rate for Payer: United Healthcare HMO Rider |
$558.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,328.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,328.55
|
|
|
HC TLSO FULL CORSET
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
905350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.06 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Adventist Health Commercial |
$136.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$183.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.57
|
| Rate for Payer: Blue Shield of California Commercial |
$257.41
|
| Rate for Payer: Blue Shield of California EPN |
$167.83
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$283.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.59
|
| Rate for Payer: InnovAge PACE Commercial |
$166.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.10
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$166.50
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: Riverside University Health System MISP |
$133.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.05
|
| Rate for Payer: Vantage Medical Group Senior |
$283.05
|
|
|
HC TLSO FULL CORSET
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT L0974
|
| Hospital Charge Code |
915350974
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Blue Shield of California Commercial |
$257.41
|
| Rate for Payer: Blue Shield of California EPN |
$167.83
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$233.10
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.60
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$216.45
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.97
|
| Rate for Payer: United Healthcare All Other HMO |
$121.64
|
| Rate for Payer: United Healthcare HMO Rider |
$119.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.06
|
|
