|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
IP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
915350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$625.20 |
| Max. Negotiated Rate |
$2,813.40 |
| Rate for Payer: Adventist Health Commercial |
$625.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,416.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,575.50
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,500.80
|
| Rate for Payer: Cigna of CA HMO |
$2,188.20
|
| Rate for Payer: Cigna of CA PPO |
$2,188.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.40
|
| Rate for Payer: Galaxy Health WC |
$2,657.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,813.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,191.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,934.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.20
|
| Rate for Payer: Multiplan Commercial |
$2,344.50
|
| Rate for Payer: Networks By Design Commercial |
$2,031.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,173.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,141.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1,117.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.76
|
|
|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
IP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
905350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$625.20 |
| Max. Negotiated Rate |
$2,813.40 |
| Rate for Payer: Adventist Health Commercial |
$625.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,416.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,575.50
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,500.80
|
| Rate for Payer: Cigna of CA HMO |
$2,188.20
|
| Rate for Payer: Cigna of CA PPO |
$2,188.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.40
|
| Rate for Payer: Galaxy Health WC |
$2,657.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,813.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,191.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,934.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.20
|
| Rate for Payer: Multiplan Commercial |
$2,344.50
|
| Rate for Payer: Networks By Design Commercial |
$2,031.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,173.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,141.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1,117.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.76
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
905350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$2,192.40 |
| Rate for Payer: Adventist Health Commercial |
$487.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,883.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.74
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,948.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,192.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,507.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.20
|
| Rate for Payer: Multiplan Commercial |
$1,827.00
|
| Rate for Payer: Networks By Design Commercial |
$1,583.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.23
|
| Rate for Payer: United Healthcare All Other HMO |
$889.87
|
| Rate for Payer: United Healthcare HMO Rider |
$870.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$797.79
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
905350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$797.79 |
| Max. Negotiated Rate |
$2,192.40 |
| Rate for Payer: Adventist Health Commercial |
$998.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,339.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,827.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,430.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,883.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.74
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,948.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,070.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,192.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,675.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,218.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,851.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,507.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,705.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,705.20
|
| Rate for Payer: Multiplan Commercial |
$1,827.00
|
| Rate for Payer: Networks By Design Commercial |
$1,218.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: Riverside University Health System MISP |
$974.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,461.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,461.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.23
|
| Rate for Payer: United Healthcare All Other HMO |
$889.87
|
| Rate for Payer: United Healthcare HMO Rider |
$870.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$797.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,070.60
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
915350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$2,192.40 |
| Rate for Payer: Adventist Health Commercial |
$487.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,883.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.74
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,948.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,192.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,507.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.20
|
| Rate for Payer: Multiplan Commercial |
$1,827.00
|
| Rate for Payer: Networks By Design Commercial |
$1,583.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.23
|
| Rate for Payer: United Healthcare All Other HMO |
$889.87
|
| Rate for Payer: United Healthcare HMO Rider |
$870.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$797.79
|
|
|
HC TLSO TRIPLANAR CNTRL ANT/POST
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT L0480
|
| Hospital Charge Code |
915350480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$797.79 |
| Max. Negotiated Rate |
$2,192.40 |
| Rate for Payer: Adventist Health Commercial |
$998.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,339.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,827.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,430.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,883.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.74
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Cash Price |
$1,339.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,948.80
|
| Rate for Payer: Cigna of CA HMO |
$1,705.20
|
| Rate for Payer: Cigna of CA PPO |
$1,705.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,070.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$974.40
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,192.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,675.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,218.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,851.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,507.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,705.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,705.20
|
| Rate for Payer: Multiplan Commercial |
$1,827.00
|
| Rate for Payer: Networks By Design Commercial |
$1,218.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: Riverside University Health System MISP |
$974.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,461.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,461.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.23
|
| Rate for Payer: United Healthcare All Other HMO |
$889.87
|
| Rate for Payer: United Healthcare HMO Rider |
$870.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$797.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,070.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,070.60
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
905350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$284.93 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Adventist Health Commercial |
$356.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$652.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$510.95
|
| Rate for Payer: Blue Shield of California Commercial |
$672.51
|
| Rate for Payer: Blue Shield of California EPN |
$438.48
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Central Health Plan Commercial |
$696.00
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$739.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$739.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$558.42
|
| Rate for Payer: InnovAge PACE Commercial |
$435.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$609.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$609.00
|
| Rate for Payer: Multiplan Commercial |
$652.50
|
| Rate for Payer: Networks By Design Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Riverside University Health System MISP |
$348.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.51
|
| Rate for Payer: United Healthcare All Other HMO |
$317.81
|
| Rate for Payer: United Healthcare HMO Rider |
$310.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$739.50
|
| Rate for Payer: Vantage Medical Group Senior |
$739.50
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
905350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Blue Shield of California Commercial |
$672.51
|
| Rate for Payer: Blue Shield of California EPN |
$438.48
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Central Health Plan Commercial |
$696.00
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.00
|
| Rate for Payer: Multiplan Commercial |
$652.50
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.51
|
| Rate for Payer: United Healthcare All Other HMO |
$317.81
|
| Rate for Payer: United Healthcare HMO Rider |
$310.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.93
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
915350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Blue Shield of California Commercial |
$672.51
|
| Rate for Payer: Blue Shield of California EPN |
$438.48
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Central Health Plan Commercial |
$696.00
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.00
|
| Rate for Payer: Multiplan Commercial |
$652.50
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.51
|
| Rate for Payer: United Healthcare All Other HMO |
$317.81
|
| Rate for Payer: United Healthcare HMO Rider |
$310.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.93
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
915350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$284.93 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Adventist Health Commercial |
$356.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$652.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$510.95
|
| Rate for Payer: Blue Shield of California Commercial |
$672.51
|
| Rate for Payer: Blue Shield of California EPN |
$438.48
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Central Health Plan Commercial |
$696.00
|
| Rate for Payer: Cigna of CA HMO |
$609.00
|
| Rate for Payer: Cigna of CA PPO |
$609.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$739.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$739.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$558.42
|
| Rate for Payer: InnovAge PACE Commercial |
$435.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$609.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$609.00
|
| Rate for Payer: Multiplan Commercial |
$652.50
|
| Rate for Payer: Networks By Design Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Riverside University Health System MISP |
$348.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.51
|
| Rate for Payer: United Healthcare All Other HMO |
$317.81
|
| Rate for Payer: United Healthcare HMO Rider |
$310.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$739.50
|
| Rate for Payer: Vantage Medical Group Senior |
$739.50
|
|
|
HC TLSO TRIPLANAR CNTRL LINER 2 P
|
Facility
|
IP
|
$3,626.00
|
|
|
Service Code
|
CPT L0486
|
| Hospital Charge Code |
905350486
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$725.20 |
| Max. Negotiated Rate |
$3,263.40 |
| Rate for Payer: Adventist Health Commercial |
$725.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,802.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,827.50
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,900.80
|
| Rate for Payer: Cigna of CA HMO |
$2,538.20
|
| Rate for Payer: Cigna of CA PPO |
$2,538.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.40
|
| Rate for Payer: Galaxy Health WC |
$3,082.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,175.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,263.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,418.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,244.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.20
|
| Rate for Payer: Multiplan Commercial |
$2,719.50
|
| Rate for Payer: Networks By Design Commercial |
$2,356.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,360.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,324.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,295.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,187.52
|
|
|
HC TLSO TRIPLANAR CNTRL LINER 2 P
|
Facility
|
IP
|
$3,626.00
|
|
|
Service Code
|
CPT L0486
|
| Hospital Charge Code |
915350486
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$725.20 |
| Max. Negotiated Rate |
$3,263.40 |
| Rate for Payer: Adventist Health Commercial |
$725.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,802.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,827.50
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,900.80
|
| Rate for Payer: Cigna of CA HMO |
$2,538.20
|
| Rate for Payer: Cigna of CA PPO |
$2,538.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.40
|
| Rate for Payer: Galaxy Health WC |
$3,082.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,175.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,263.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,418.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,244.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.20
|
| Rate for Payer: Multiplan Commercial |
$2,719.50
|
| Rate for Payer: Networks By Design Commercial |
$2,356.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,360.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,324.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,295.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,187.52
|
|
|
HC TLSO TRIPLANAR CNTRL LINER 2 P
|
Facility
|
OP
|
$3,626.00
|
|
|
Service Code
|
CPT L0486
|
| Hospital Charge Code |
915350486
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,187.52 |
| Max. Negotiated Rate |
$3,263.40 |
| Rate for Payer: Adventist Health Commercial |
$1,486.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,994.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,719.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,129.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,802.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,827.50
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,900.80
|
| Rate for Payer: Cigna of CA HMO |
$2,538.20
|
| Rate for Payer: Cigna of CA PPO |
$2,538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,082.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,082.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.40
|
| Rate for Payer: Galaxy Health WC |
$3,082.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,175.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,263.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,329.03
|
| Rate for Payer: InnovAge PACE Commercial |
$1,813.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,418.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,244.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,538.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,538.20
|
| Rate for Payer: Multiplan Commercial |
$2,719.50
|
| Rate for Payer: Networks By Design Commercial |
$1,813.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.10
|
| Rate for Payer: Riverside University Health System MISP |
$1,450.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,175.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,175.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,360.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,324.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,295.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,187.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,082.10
|
|
|
HC TLSO TRIPLANAR CNTRL LINER 2 P
|
Facility
|
OP
|
$3,626.00
|
|
|
Service Code
|
CPT L0486
|
| Hospital Charge Code |
905350486
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,187.52 |
| Max. Negotiated Rate |
$3,263.40 |
| Rate for Payer: Adventist Health Commercial |
$1,486.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,994.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,719.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,129.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,802.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,827.50
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,900.80
|
| Rate for Payer: Cigna of CA HMO |
$2,538.20
|
| Rate for Payer: Cigna of CA PPO |
$2,538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,082.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,082.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.40
|
| Rate for Payer: Galaxy Health WC |
$3,082.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,175.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,263.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,329.03
|
| Rate for Payer: InnovAge PACE Commercial |
$1,813.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,418.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,244.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,538.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,538.20
|
| Rate for Payer: Multiplan Commercial |
$2,719.50
|
| Rate for Payer: Networks By Design Commercial |
$1,813.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.10
|
| Rate for Payer: Riverside University Health System MISP |
$1,450.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,175.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,175.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,360.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,324.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,295.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,187.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,082.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,082.10
|
|
|
HC TLSO TRIPLANAR CNTRL LINER ANT
|
Facility
|
IP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
915350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.60 |
| Max. Negotiated Rate |
$2,500.20 |
| Rate for Payer: Adventist Health Commercial |
$555.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,147.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.11
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,222.40
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,500.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,058.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.60
|
| Rate for Payer: Multiplan Commercial |
$2,083.50
|
| Rate for Payer: Networks By Design Commercial |
$1,805.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.80
|
| Rate for Payer: United Healthcare HMO Rider |
$992.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$909.79
|
|
|
HC TLSO TRIPLANAR CNTRL LINER ANT
|
Facility
|
OP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
905350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$909.79 |
| Max. Negotiated Rate |
$2,500.20 |
| Rate for Payer: Adventist Health Commercial |
$1,138.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,527.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,083.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,631.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,147.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.11
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,222.40
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,361.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,361.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,500.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,910.94
|
| Rate for Payer: InnovAge PACE Commercial |
$1,389.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,110.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,138.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,944.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,944.60
|
| Rate for Payer: Multiplan Commercial |
$2,083.50
|
| Rate for Payer: Networks By Design Commercial |
$1,389.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,111.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,666.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,666.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.80
|
| Rate for Payer: United Healthcare HMO Rider |
$992.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$909.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,361.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,361.30
|
|
|
HC TLSO TRIPLANAR CNTRL LINER ANT
|
Facility
|
OP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
915350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$909.79 |
| Max. Negotiated Rate |
$2,500.20 |
| Rate for Payer: Adventist Health Commercial |
$1,138.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,527.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,083.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,631.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,147.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.11
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,222.40
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,361.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,361.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,500.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,910.94
|
| Rate for Payer: InnovAge PACE Commercial |
$1,389.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,110.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,138.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,944.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,944.60
|
| Rate for Payer: Multiplan Commercial |
$2,083.50
|
| Rate for Payer: Networks By Design Commercial |
$1,389.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,111.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,666.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,666.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.80
|
| Rate for Payer: United Healthcare HMO Rider |
$992.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$909.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,361.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,361.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,361.30
|
|
|
HC TLSO TRIPLANAR CNTRL LINER ANT
|
Facility
|
IP
|
$2,778.00
|
|
|
Service Code
|
CPT L0482
|
| Hospital Charge Code |
905350482
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.60 |
| Max. Negotiated Rate |
$2,500.20 |
| Rate for Payer: Adventist Health Commercial |
$555.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,147.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.11
|
| Rate for Payer: Cash Price |
$1,527.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,222.40
|
| Rate for Payer: Cigna of CA HMO |
$1,944.60
|
| Rate for Payer: Cigna of CA PPO |
$1,944.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,500.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,058.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.60
|
| Rate for Payer: Multiplan Commercial |
$2,083.50
|
| Rate for Payer: Networks By Design Commercial |
$1,805.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.80
|
| Rate for Payer: United Healthcare HMO Rider |
$992.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$909.79
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
905350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Adventist Health Commercial |
$562.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$754.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,028.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$805.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,059.78
|
| Rate for Payer: Blue Shield of California EPN |
$690.98
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.80
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,165.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,165.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Senior |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$880.50
|
| Rate for Payer: InnovAge PACE Commercial |
$685.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$972.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.70
|
| Rate for Payer: Multiplan Commercial |
$1,028.25
|
| Rate for Payer: Networks By Design Commercial |
$685.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: Riverside University Health System MISP |
$548.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.54
|
| Rate for Payer: United Healthcare All Other HMO |
$500.83
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,165.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,165.35
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
905350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.20 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Adventist Health Commercial |
$274.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,059.78
|
| Rate for Payer: Blue Shield of California EPN |
$690.98
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.80
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Senior |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.20
|
| Rate for Payer: Multiplan Commercial |
$1,028.25
|
| Rate for Payer: Networks By Design Commercial |
$891.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.54
|
| Rate for Payer: United Healthcare All Other HMO |
$500.83
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.00
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
915350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.20 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Adventist Health Commercial |
$274.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,059.78
|
| Rate for Payer: Blue Shield of California EPN |
$690.98
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.80
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Senior |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.20
|
| Rate for Payer: Multiplan Commercial |
$1,028.25
|
| Rate for Payer: Networks By Design Commercial |
$891.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.54
|
| Rate for Payer: United Healthcare All Other HMO |
$500.83
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.00
|
|
|
HC TLSO TRIPLANAR CNTRL RIGID POS
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT L0470
|
| Hospital Charge Code |
915350470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Adventist Health Commercial |
$562.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$754.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,028.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$805.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,059.78
|
| Rate for Payer: Blue Shield of California EPN |
$690.98
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Cash Price |
$754.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.80
|
| Rate for Payer: Cigna of CA HMO |
$959.70
|
| Rate for Payer: Cigna of CA PPO |
$959.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,165.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,165.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.40
|
| Rate for Payer: EPIC Health Plan Senior |
$548.40
|
| Rate for Payer: Galaxy Health WC |
$1,165.35
|
| Rate for Payer: Global Benefits Group Commercial |
$822.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$880.50
|
| Rate for Payer: InnovAge PACE Commercial |
$685.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$914.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$972.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.70
|
| Rate for Payer: Multiplan Commercial |
$1,028.25
|
| Rate for Payer: Networks By Design Commercial |
$685.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,165.35
|
| Rate for Payer: Riverside University Health System MISP |
$548.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.54
|
| Rate for Payer: United Healthcare All Other HMO |
$500.83
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,165.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,165.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,165.35
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
905350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$984.60 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Blue Shield of California Commercial |
$845.66
|
| Rate for Payer: Blue Shield of California EPN |
$551.38
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
915350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Adventist Health Commercial |
$480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,855.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,920.00
|
| Rate for Payer: Cigna of CA HMO |
$1,680.00
|
| Rate for Payer: Cigna of CA PPO |
$1,680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$960.00
|
| Rate for Payer: Galaxy Health WC |
$2,040.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,440.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,600.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$914.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,485.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.00
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: Networks By Design Commercial |
$1,560.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.72
|
| Rate for Payer: United Healthcare All Other HMO |
$876.72
|
| Rate for Payer: United Healthcare HMO Rider |
$857.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.00
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
905350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$358.29 |
| Max. Negotiated Rate |
$1,491.23 |
| Rate for Payer: Adventist Health Commercial |
$448.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$642.51
|
| Rate for Payer: Blue Shield of California Commercial |
$845.66
|
| Rate for Payer: Blue Shield of California EPN |
$551.38
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,349.96
|
| Rate for Payer: InnovAge PACE Commercial |
$547.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,491.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Riverside University Health System MISP |
$437.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
