|
HC LSO CORSET FRONT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
915350972
|
|
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 |
$327.22
|
| Rate for Payer: Blue Shield of California EPN |
$205.63
|
| Rate for Payer: Cash Price |
$183.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| 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 LSO FLEX CORSET W/RIGID STAYS S1-T9 CUSTOM
|
Facility
|
IP
|
$3,047.00
|
|
|
Service Code
|
CPT L0629
|
| Hospital Charge Code |
905350629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.40 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Adventist Health Commercial |
$609.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,443.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.69
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,742.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,797.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.40
|
| Rate for Payer: Multiplan Commercial |
$2,285.25
|
| Rate for Payer: Networks By Design Commercial |
$1,980.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.89
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 CUSTOM
|
Facility
|
OP
|
$3,047.00
|
|
|
Service Code
|
CPT L0629
|
| Hospital Charge Code |
905350629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$997.89 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Adventist Health Commercial |
$1,249.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,675.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,285.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,772.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,443.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.69
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,589.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,589.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,742.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,797.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,132.90
|
| Rate for Payer: Multiplan Commercial |
$2,285.25
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,218.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,828.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,828.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,589.95
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 CUSTOM
|
Facility
|
IP
|
$3,047.00
|
|
|
Service Code
|
CPT L0629
|
| Hospital Charge Code |
915350629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.40 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Adventist Health Commercial |
$609.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,443.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.69
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,742.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,797.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.40
|
| Rate for Payer: Multiplan Commercial |
$2,285.25
|
| Rate for Payer: Networks By Design Commercial |
$1,980.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.89
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 CUSTOM
|
Facility
|
OP
|
$3,047.00
|
|
|
Service Code
|
CPT L0629
|
| Hospital Charge Code |
915350629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$997.89 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Adventist Health Commercial |
$1,249.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,675.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,285.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,772.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,443.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.69
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,589.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,589.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,742.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,797.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,132.90
|
| Rate for Payer: Multiplan Commercial |
$2,285.25
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,218.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,828.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,828.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,589.95
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 PREFAB
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT L0628
|
| Hospital Charge Code |
905340628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Blue Shield of California Commercial |
$152.38
|
| Rate for Payer: Blue Shield of California EPN |
$95.76
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 PREFAB
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT L0628
|
| Hospital Charge Code |
915340628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$77.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.52
|
| Rate for Payer: Blue Shield of California Commercial |
$152.38
|
| Rate for Payer: Blue Shield of California EPN |
$95.76
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$161.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Riverside University Health System MISP |
$76.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.50
|
| Rate for Payer: Vantage Medical Group Senior |
$161.50
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 PREFAB
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT L0628
|
| Hospital Charge Code |
915340628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Blue Shield of California Commercial |
$152.38
|
| Rate for Payer: Blue Shield of California EPN |
$95.76
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
|
|
HC LSO FLEX CORSET W/RIGID STAYS S1-T9 PREFAB
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT L0628
|
| Hospital Charge Code |
905340628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$77.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.52
|
| Rate for Payer: Blue Shield of California Commercial |
$152.38
|
| Rate for Payer: Blue Shield of California EPN |
$95.76
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$161.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Riverside University Health System MISP |
$76.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.50
|
| Rate for Payer: Vantage Medical Group Senior |
$161.50
|
|
|
HC LSO, FLEXION CONTROL, CUSTOM
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT L0634
|
| Hospital Charge Code |
905350634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.19 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$361.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$233.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$318.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.22
|
| Rate for Payer: Blue Shield of California Commercial |
$340.85
|
| Rate for Payer: Blue Shield of California EPN |
$214.20
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Central Health Plan Commercial |
$340.00
|
| Rate for Payer: Cigna of CA HMO |
$297.50
|
| Rate for Payer: Cigna of CA PPO |
$297.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$361.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$361.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$361.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$382.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$297.50
|
| Rate for Payer: Multiplan Commercial |
$318.75
|
| Rate for Payer: Networks By Design Commercial |
$212.50
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
| Rate for Payer: Riverside University Health System MISP |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.25
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$361.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$361.25
|
| Rate for Payer: Vantage Medical Group Senior |
$361.25
|
|
|
HC LSO, FLEXION CONTROL, CUSTOM
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT L0634
|
| Hospital Charge Code |
905350634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$85.00
|
| Rate for Payer: Blue Shield of California Commercial |
$340.85
|
| Rate for Payer: Blue Shield of California EPN |
$214.20
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Central Health Plan Commercial |
$340.00
|
| Rate for Payer: Cigna of CA HMO |
$297.50
|
| Rate for Payer: Cigna of CA PPO |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$382.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.00
|
| Rate for Payer: Multiplan Commercial |
$318.75
|
| Rate for Payer: Networks By Design Commercial |
$276.25
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.25
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.19
|
|
|
HC LSO, FLEXION CONTROL, CUSTOM
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT L0634
|
| Hospital Charge Code |
915350634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$85.00
|
| Rate for Payer: Blue Shield of California Commercial |
$340.85
|
| Rate for Payer: Blue Shield of California EPN |
$214.20
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Central Health Plan Commercial |
$340.00
|
| Rate for Payer: Cigna of CA HMO |
$297.50
|
| Rate for Payer: Cigna of CA PPO |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$382.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.00
|
| Rate for Payer: Multiplan Commercial |
$318.75
|
| Rate for Payer: Networks By Design Commercial |
$276.25
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.25
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.19
|
|
|
HC LSO, FLEXION CONTROL, CUSTOM
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT L0634
|
| Hospital Charge Code |
915350634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.19 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$361.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$233.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$318.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.22
|
| Rate for Payer: Blue Shield of California Commercial |
$340.85
|
| Rate for Payer: Blue Shield of California EPN |
$214.20
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Central Health Plan Commercial |
$340.00
|
| Rate for Payer: Cigna of CA HMO |
$297.50
|
| Rate for Payer: Cigna of CA PPO |
$297.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$361.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$361.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$361.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$382.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$297.50
|
| Rate for Payer: Multiplan Commercial |
$318.75
|
| Rate for Payer: Networks By Design Commercial |
$212.50
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
| Rate for Payer: Riverside University Health System MISP |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.50
|
| Rate for Payer: United Healthcare All Other HMO |
$155.25
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$361.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$361.25
|
| Rate for Payer: Vantage Medical Group Senior |
$361.25
|
|
|
HC LSO FLEXION CONTROL PREFAB
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT L0633
|
| Hospital Charge Code |
905350633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Blue Shield of California Commercial |
$368.92
|
| Rate for Payer: Blue Shield of California EPN |
$231.84
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$322.00
|
| Rate for Payer: Cigna of CA PPO |
$322.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.64
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$164.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.65
|
|
|
HC LSO FLEXION CONTROL PREFAB
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT L0633
|
| Hospital Charge Code |
915350633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.58
|
| Rate for Payer: Blue Shield of California Commercial |
$368.92
|
| Rate for Payer: Blue Shield of California EPN |
$231.84
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$322.00
|
| Rate for Payer: Cigna of CA PPO |
$322.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$310.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$230.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Riverside University Health System MISP |
$184.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.64
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$164.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC LSO FLEXION CONTROL PREFAB
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT L0633
|
| Hospital Charge Code |
915350633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Blue Shield of California Commercial |
$368.92
|
| Rate for Payer: Blue Shield of California EPN |
$231.84
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$322.00
|
| Rate for Payer: Cigna of CA PPO |
$322.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.64
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$164.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.65
|
|
|
HC LSO FLEXION CONTROL PREFAB
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT L0633
|
| Hospital Charge Code |
905350633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.58
|
| Rate for Payer: Blue Shield of California Commercial |
$368.92
|
| Rate for Payer: Blue Shield of California EPN |
$231.84
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$322.00
|
| Rate for Payer: Cigna of CA PPO |
$322.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$310.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$230.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Riverside University Health System MISP |
$184.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.64
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$164.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC LSO FULL CORSET
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
905350976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.77 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.90
|
| Rate for Payer: Blue Shield of California Commercial |
$214.94
|
| Rate for Payer: Blue Shield of California EPN |
$135.07
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$134.00
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Riverside University Health System MISP |
$107.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC LSO FULL CORSET
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
915350976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.77 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.90
|
| Rate for Payer: Blue Shield of California Commercial |
$214.94
|
| Rate for Payer: Blue Shield of California EPN |
$135.07
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$134.00
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Riverside University Health System MISP |
$107.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC LSO FULL CORSET
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
905350976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Blue Shield of California Commercial |
$214.94
|
| Rate for Payer: Blue Shield of California EPN |
$135.07
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
|
|
HC LSO FULL CORSET
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
915350976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Blue Shield of California Commercial |
$214.94
|
| Rate for Payer: Blue Shield of California EPN |
$135.07
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$187.60
|
| Rate for Payer: Cigna of CA PPO |
$187.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.58
|
| Rate for Payer: United Healthcare All Other HMO |
$97.90
|
| Rate for Payer: United Healthcare HMO Rider |
$95.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
|
|
HC LSO POST RIGID PANEL PRE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L0630
|
| Hospital Charge Code |
915350630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.88
|
| Rate for Payer: Blue Shield of California Commercial |
$224.56
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Riverside University Health System MISP |
$112.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.08
|
| Rate for Payer: United Healthcare All Other HMO |
$102.28
|
| Rate for Payer: United Healthcare HMO Rider |
$100.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC LSO POST RIGID PANEL PRE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L0630
|
| Hospital Charge Code |
905350630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.88
|
| Rate for Payer: Blue Shield of California Commercial |
$224.56
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Riverside University Health System MISP |
$112.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.08
|
| Rate for Payer: United Healthcare All Other HMO |
$102.28
|
| Rate for Payer: United Healthcare HMO Rider |
$100.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC LSO POST RIGID PANEL PRE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT L0630
|
| Hospital Charge Code |
915350630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.56
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.08
|
| Rate for Payer: United Healthcare All Other HMO |
$102.28
|
| Rate for Payer: United Healthcare HMO Rider |
$100.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.70
|
|
|
HC LSO POST RIGID PANEL PRE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT L0630
|
| Hospital Charge Code |
905350630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.56
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.08
|
| Rate for Payer: United Healthcare All Other HMO |
$102.28
|
| Rate for Payer: United Healthcare HMO Rider |
$100.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.70
|
|
