|
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 |
$216.44
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$154.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| 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
|
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 |
$164.44
|
| Rate for Payer: Blue Shield of California Commercial |
$216.44
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| 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: 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: InnovAge PACE Commercial |
$140.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$164.44
|
| Rate for Payer: Blue Shield of California Commercial |
$216.44
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| 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: 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: InnovAge PACE Commercial |
$140.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$216.44
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$154.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| 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 SAG-CORONAL PANEL CUSTOM
|
Facility
|
OP
|
$2,220.00
|
|
|
Service Code
|
CPT L0638
|
| Hospital Charge Code |
905350638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$727.05 |
| Max. Negotiated Rate |
$1,998.00 |
| Rate for Payer: Adventist Health Commercial |
$910.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,221.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,716.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.88
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,776.00
|
| Rate for Payer: Cigna of CA HMO |
$1,554.00
|
| Rate for Payer: Cigna of CA PPO |
$1,554.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,887.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,887.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.00
|
| Rate for Payer: EPIC Health Plan Senior |
$888.00
|
| Rate for Payer: Galaxy Health WC |
$1,887.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,332.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,998.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,426.02
|
| Rate for Payer: InnovAge PACE Commercial |
$1,110.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,374.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,554.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,554.00
|
| Rate for Payer: Multiplan Commercial |
$1,665.00
|
| Rate for Payer: Networks By Design Commercial |
$1,110.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,887.00
|
| Rate for Payer: Riverside University Health System MISP |
$888.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,332.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,332.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$833.17
|
| Rate for Payer: United Healthcare All Other HMO |
$810.97
|
| Rate for Payer: United Healthcare HMO Rider |
$793.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,887.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,887.00
|
|
|
HC LSO SAG-CORONAL PANEL CUSTOM
|
Facility
|
IP
|
$2,220.00
|
|
|
Service Code
|
CPT L0638
|
| Hospital Charge Code |
915350638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.00 |
| Max. Negotiated Rate |
$1,998.00 |
| Rate for Payer: Adventist Health Commercial |
$444.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,716.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.88
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,776.00
|
| Rate for Payer: Cigna of CA HMO |
$1,554.00
|
| Rate for Payer: Cigna of CA PPO |
$1,554.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.00
|
| Rate for Payer: EPIC Health Plan Senior |
$888.00
|
| Rate for Payer: Galaxy Health WC |
$1,887.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,332.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,998.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,374.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$1,665.00
|
| Rate for Payer: Networks By Design Commercial |
$1,443.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,887.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$833.17
|
| Rate for Payer: United Healthcare All Other HMO |
$810.97
|
| Rate for Payer: United Healthcare HMO Rider |
$793.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.05
|
|
|
HC LSO SAG-CORONAL PANEL CUSTOM
|
Facility
|
OP
|
$2,220.00
|
|
|
Service Code
|
CPT L0638
|
| Hospital Charge Code |
915350638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$727.05 |
| Max. Negotiated Rate |
$1,998.00 |
| Rate for Payer: Adventist Health Commercial |
$910.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,221.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,716.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.88
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,776.00
|
| Rate for Payer: Cigna of CA HMO |
$1,554.00
|
| Rate for Payer: Cigna of CA PPO |
$1,554.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,887.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,887.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.00
|
| Rate for Payer: EPIC Health Plan Senior |
$888.00
|
| Rate for Payer: Galaxy Health WC |
$1,887.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,332.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,998.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,426.02
|
| Rate for Payer: InnovAge PACE Commercial |
$1,110.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,374.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,554.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,554.00
|
| Rate for Payer: Multiplan Commercial |
$1,665.00
|
| Rate for Payer: Networks By Design Commercial |
$1,110.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,887.00
|
| Rate for Payer: Riverside University Health System MISP |
$888.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,332.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,332.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$833.17
|
| Rate for Payer: United Healthcare All Other HMO |
$810.97
|
| Rate for Payer: United Healthcare HMO Rider |
$793.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,887.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,887.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,887.00
|
|
|
HC LSO SAG-CORONAL PANEL CUSTOM
|
Facility
|
IP
|
$2,220.00
|
|
|
Service Code
|
CPT L0638
|
| Hospital Charge Code |
905350638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.00 |
| Max. Negotiated Rate |
$1,998.00 |
| Rate for Payer: Adventist Health Commercial |
$444.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,716.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.88
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,776.00
|
| Rate for Payer: Cigna of CA HMO |
$1,554.00
|
| Rate for Payer: Cigna of CA PPO |
$1,554.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.00
|
| Rate for Payer: EPIC Health Plan Senior |
$888.00
|
| Rate for Payer: Galaxy Health WC |
$1,887.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,332.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,998.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,374.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$1,665.00
|
| Rate for Payer: Networks By Design Commercial |
$1,443.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,887.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$833.17
|
| Rate for Payer: United Healthcare All Other HMO |
$810.97
|
| Rate for Payer: United Healthcare HMO Rider |
$793.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.05
|
|
|
HC LSO SAG-CORONAL PANEL PREFAB
|
Facility
|
OP
|
$2,037.00
|
|
|
Service Code
|
CPT L0637
|
| Hospital Charge Code |
905350637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$667.12 |
| Max. Negotiated Rate |
$1,833.30 |
| Rate for Payer: Adventist Health Commercial |
$835.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,731.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,120.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,527.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,196.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,574.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,026.65
|
| Rate for Payer: Cash Price |
$1,120.35
|
| Rate for Payer: Cash Price |
$1,120.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,629.60
|
| Rate for Payer: Cigna of CA HMO |
$1,425.90
|
| Rate for Payer: Cigna of CA PPO |
$1,425.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,731.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,731.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,731.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.80
|
| Rate for Payer: EPIC Health Plan Senior |
$814.80
|
| Rate for Payer: Galaxy Health WC |
$1,731.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,222.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,833.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,308.08
|
| Rate for Payer: InnovAge PACE Commercial |
$1,018.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,444.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.90
|
| Rate for Payer: Multiplan Commercial |
$1,527.75
|
| Rate for Payer: Networks By Design Commercial |
$1,018.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,731.45
|
| Rate for Payer: Riverside University Health System MISP |
$814.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,222.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,222.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.49
|
| Rate for Payer: United Healthcare All Other HMO |
$744.12
|
| Rate for Payer: United Healthcare HMO Rider |
$728.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$667.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,731.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,731.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,731.45
|
|
|
HC LSO SAG-CORONAL PANEL PREFAB
|
Facility
|
IP
|
$2,037.00
|
|
|
Service Code
|
CPT L0637
|
| Hospital Charge Code |
905350637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$1,833.30 |
| Rate for Payer: Adventist Health Commercial |
$407.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,574.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,026.65
|
| Rate for Payer: Cash Price |
$1,120.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,629.60
|
| Rate for Payer: Cigna of CA HMO |
$1,425.90
|
| Rate for Payer: Cigna of CA PPO |
$1,425.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.80
|
| Rate for Payer: EPIC Health Plan Senior |
$814.80
|
| Rate for Payer: Galaxy Health WC |
$1,731.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,222.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,833.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$776.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.40
|
| Rate for Payer: Multiplan Commercial |
$1,527.75
|
| Rate for Payer: Networks By Design Commercial |
$1,324.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,731.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.49
|
| Rate for Payer: United Healthcare All Other HMO |
$744.12
|
| Rate for Payer: United Healthcare HMO Rider |
$728.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$667.12
|
|
|
HC LSO SAG-CORONAL PANEL PREFAB
|
Facility
|
IP
|
$2,037.00
|
|
|
Service Code
|
CPT L0637
|
| Hospital Charge Code |
915350637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$1,833.30 |
| Rate for Payer: Adventist Health Commercial |
$407.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,574.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,026.65
|
| Rate for Payer: Cash Price |
$1,120.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,629.60
|
| Rate for Payer: Cigna of CA HMO |
$1,425.90
|
| Rate for Payer: Cigna of CA PPO |
$1,425.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.80
|
| Rate for Payer: EPIC Health Plan Senior |
$814.80
|
| Rate for Payer: Galaxy Health WC |
$1,731.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,222.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,833.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$776.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.40
|
| Rate for Payer: Multiplan Commercial |
$1,527.75
|
| Rate for Payer: Networks By Design Commercial |
$1,324.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,731.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.49
|
| Rate for Payer: United Healthcare All Other HMO |
$744.12
|
| Rate for Payer: United Healthcare HMO Rider |
$728.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$667.12
|
|
|
HC LSO SAG-CORONAL PANEL PREFAB
|
Facility
|
OP
|
$2,037.00
|
|
|
Service Code
|
CPT L0637
|
| Hospital Charge Code |
915350637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$667.12 |
| Max. Negotiated Rate |
$1,833.30 |
| Rate for Payer: Adventist Health Commercial |
$835.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,731.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,120.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,527.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,196.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,574.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,026.65
|
| Rate for Payer: Cash Price |
$1,120.35
|
| Rate for Payer: Cash Price |
$1,120.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,629.60
|
| Rate for Payer: Cigna of CA HMO |
$1,425.90
|
| Rate for Payer: Cigna of CA PPO |
$1,425.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,731.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,731.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,731.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.80
|
| Rate for Payer: EPIC Health Plan Senior |
$814.80
|
| Rate for Payer: Galaxy Health WC |
$1,731.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,222.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,833.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,308.08
|
| Rate for Payer: InnovAge PACE Commercial |
$1,018.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,444.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.90
|
| Rate for Payer: Multiplan Commercial |
$1,527.75
|
| Rate for Payer: Networks By Design Commercial |
$1,018.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,731.45
|
| Rate for Payer: Riverside University Health System MISP |
$814.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,222.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,222.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.49
|
| Rate for Payer: United Healthcare All Other HMO |
$744.12
|
| Rate for Payer: United Healthcare HMO Rider |
$728.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$667.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,731.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,731.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,731.45
|
|
|
HC LSO SAG-CORO REGID FRAME PRE
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
CPT L0631
|
| Hospital Charge Code |
905350631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$635.35 |
| Max. Negotiated Rate |
$1,746.00 |
| Rate for Payer: Adventist Health Commercial |
$795.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,649.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,067.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,455.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,139.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,499.62
|
| Rate for Payer: Blue Shield of California EPN |
$977.76
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,552.00
|
| Rate for Payer: Cigna of CA HMO |
$1,358.00
|
| Rate for Payer: Cigna of CA PPO |
$1,358.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,649.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,649.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,649.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$776.00
|
| Rate for Payer: EPIC Health Plan Senior |
$776.00
|
| Rate for Payer: Galaxy Health WC |
$1,649.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,164.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,746.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,109.93
|
| Rate for Payer: InnovAge PACE Commercial |
$970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,226.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,200.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,358.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,358.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: Networks By Design Commercial |
$970.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,649.00
|
| Rate for Payer: Riverside University Health System MISP |
$776.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,164.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,164.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$728.08
|
| Rate for Payer: United Healthcare All Other HMO |
$708.68
|
| Rate for Payer: United Healthcare HMO Rider |
$693.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,649.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,649.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,649.00
|
|
|
HC LSO SAG-CORO REGID FRAME PRE
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT L0631
|
| Hospital Charge Code |
905350631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$388.00 |
| Max. Negotiated Rate |
$1,746.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,499.62
|
| Rate for Payer: Blue Shield of California EPN |
$977.76
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,552.00
|
| Rate for Payer: Cigna of CA HMO |
$1,358.00
|
| Rate for Payer: Cigna of CA PPO |
$1,358.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$776.00
|
| Rate for Payer: EPIC Health Plan Senior |
$776.00
|
| Rate for Payer: Galaxy Health WC |
$1,649.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,164.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,746.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$739.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,200.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: Networks By Design Commercial |
$1,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,649.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$728.08
|
| Rate for Payer: United Healthcare All Other HMO |
$708.68
|
| Rate for Payer: United Healthcare HMO Rider |
$693.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.35
|
|
|
HC LSO SAG-CORO REGID FRAME PRE
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT L0631
|
| Hospital Charge Code |
915350631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$388.00 |
| Max. Negotiated Rate |
$1,746.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,499.62
|
| Rate for Payer: Blue Shield of California EPN |
$977.76
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,552.00
|
| Rate for Payer: Cigna of CA HMO |
$1,358.00
|
| Rate for Payer: Cigna of CA PPO |
$1,358.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$776.00
|
| Rate for Payer: EPIC Health Plan Senior |
$776.00
|
| Rate for Payer: Galaxy Health WC |
$1,649.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,164.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,746.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$739.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,200.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: Networks By Design Commercial |
$1,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,649.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$728.08
|
| Rate for Payer: United Healthcare All Other HMO |
$708.68
|
| Rate for Payer: United Healthcare HMO Rider |
$693.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.35
|
|
|
HC LSO SAG-CORO REGID FRAME PRE
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
CPT L0631
|
| Hospital Charge Code |
915350631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$635.35 |
| Max. Negotiated Rate |
$1,746.00 |
| Rate for Payer: Adventist Health Commercial |
$795.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,649.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,067.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,455.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,139.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,499.62
|
| Rate for Payer: Blue Shield of California EPN |
$977.76
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,552.00
|
| Rate for Payer: Cigna of CA HMO |
$1,358.00
|
| Rate for Payer: Cigna of CA PPO |
$1,358.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,649.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,649.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,649.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$776.00
|
| Rate for Payer: EPIC Health Plan Senior |
$776.00
|
| Rate for Payer: Galaxy Health WC |
$1,649.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,164.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,746.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,109.93
|
| Rate for Payer: InnovAge PACE Commercial |
$970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,226.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,200.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,358.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,358.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: Networks By Design Commercial |
$970.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,649.00
|
| Rate for Payer: Riverside University Health System MISP |
$776.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,164.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,164.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$728.08
|
| Rate for Payer: United Healthcare All Other HMO |
$708.68
|
| Rate for Payer: United Healthcare HMO Rider |
$693.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,649.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,649.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,649.00
|
|
|
HC LSO SAG-COR RIGID SHELL/PANEL PREFAB
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT L0639
|
| Hospital Charge Code |
915340639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$625.52 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Adventist Health Commercial |
$783.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,623.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,050.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,432.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,121.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,476.43
|
| Rate for Payer: Blue Shield of California EPN |
$962.64
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,528.00
|
| Rate for Payer: Cigna of CA HMO |
$1,337.00
|
| Rate for Payer: Cigna of CA PPO |
$1,337.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,623.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,623.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,623.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.00
|
| Rate for Payer: EPIC Health Plan Senior |
$764.00
|
| Rate for Payer: Galaxy Health WC |
$1,623.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,146.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,719.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,308.08
|
| Rate for Payer: InnovAge PACE Commercial |
$955.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,273.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,444.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,182.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,337.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,337.00
|
| Rate for Payer: Multiplan Commercial |
$1,432.50
|
| Rate for Payer: Networks By Design Commercial |
$955.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,623.50
|
| Rate for Payer: Riverside University Health System MISP |
$764.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,146.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,146.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$716.82
|
| Rate for Payer: United Healthcare All Other HMO |
$697.72
|
| Rate for Payer: United Healthcare HMO Rider |
$682.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$625.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,623.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,623.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,623.50
|
|
|
HC LSO SAG-COR RIGID SHELL/PANEL PREFAB
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT L0639
|
| Hospital Charge Code |
915340639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$382.00 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Adventist Health Commercial |
$382.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,476.43
|
| Rate for Payer: Blue Shield of California EPN |
$962.64
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,528.00
|
| Rate for Payer: Cigna of CA HMO |
$1,337.00
|
| Rate for Payer: Cigna of CA PPO |
$1,337.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.00
|
| Rate for Payer: EPIC Health Plan Senior |
$764.00
|
| Rate for Payer: Galaxy Health WC |
$1,623.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,146.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,273.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$727.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,182.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.00
|
| Rate for Payer: Multiplan Commercial |
$1,432.50
|
| Rate for Payer: Networks By Design Commercial |
$1,241.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,623.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$716.82
|
| Rate for Payer: United Healthcare All Other HMO |
$697.72
|
| Rate for Payer: United Healthcare HMO Rider |
$682.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$625.52
|
|
|
HC LSO SAGIT RIGID PANEL PREFAB
|
Facility
|
OP
|
$2,310.00
|
|
|
Service Code
|
CPT L0635
|
| Hospital Charge Code |
915350635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$756.52 |
| Max. Negotiated Rate |
$2,079.00 |
| Rate for Payer: Adventist Health Commercial |
$947.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,963.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,270.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,732.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,356.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,785.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,164.24
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,848.00
|
| Rate for Payer: Cigna of CA HMO |
$1,617.00
|
| Rate for Payer: Cigna of CA PPO |
$1,617.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,963.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,963.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,963.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.00
|
| Rate for Payer: EPIC Health Plan Senior |
$924.00
|
| Rate for Payer: Galaxy Health WC |
$1,963.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,079.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,321.96
|
| Rate for Payer: InnovAge PACE Commercial |
$1,155.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,540.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,460.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,429.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,617.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,617.00
|
| Rate for Payer: Multiplan Commercial |
$1,732.50
|
| Rate for Payer: Networks By Design Commercial |
$1,155.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,963.50
|
| Rate for Payer: Riverside University Health System MISP |
$924.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.94
|
| Rate for Payer: United Healthcare All Other HMO |
$843.84
|
| Rate for Payer: United Healthcare HMO Rider |
$825.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$756.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,963.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,963.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,963.50
|
|
|
HC LSO SAGIT RIGID PANEL PREFAB
|
Facility
|
OP
|
$2,310.00
|
|
|
Service Code
|
CPT L0635
|
| Hospital Charge Code |
905350635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$756.52 |
| Max. Negotiated Rate |
$2,079.00 |
| Rate for Payer: Adventist Health Commercial |
$947.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,963.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,270.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,732.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,356.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,785.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,164.24
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,848.00
|
| Rate for Payer: Cigna of CA HMO |
$1,617.00
|
| Rate for Payer: Cigna of CA PPO |
$1,617.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,963.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,963.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,963.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.00
|
| Rate for Payer: EPIC Health Plan Senior |
$924.00
|
| Rate for Payer: Galaxy Health WC |
$1,963.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,079.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,321.96
|
| Rate for Payer: InnovAge PACE Commercial |
$1,155.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,540.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,460.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,429.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,617.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,617.00
|
| Rate for Payer: Multiplan Commercial |
$1,732.50
|
| Rate for Payer: Networks By Design Commercial |
$1,155.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,963.50
|
| Rate for Payer: Riverside University Health System MISP |
$924.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.94
|
| Rate for Payer: United Healthcare All Other HMO |
$843.84
|
| Rate for Payer: United Healthcare HMO Rider |
$825.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$756.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,963.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,963.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,963.50
|
|
|
HC LSO SAGIT RIGID PANEL PREFAB
|
Facility
|
IP
|
$2,310.00
|
|
|
Service Code
|
CPT L0635
|
| Hospital Charge Code |
915350635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$2,079.00 |
| Rate for Payer: Adventist Health Commercial |
$462.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,785.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,164.24
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,848.00
|
| Rate for Payer: Cigna of CA HMO |
$1,617.00
|
| Rate for Payer: Cigna of CA PPO |
$1,617.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.00
|
| Rate for Payer: EPIC Health Plan Senior |
$924.00
|
| Rate for Payer: Galaxy Health WC |
$1,963.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,079.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,540.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,429.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.00
|
| Rate for Payer: Multiplan Commercial |
$1,732.50
|
| Rate for Payer: Networks By Design Commercial |
$1,501.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,963.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.94
|
| Rate for Payer: United Healthcare All Other HMO |
$843.84
|
| Rate for Payer: United Healthcare HMO Rider |
$825.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$756.52
|
|
|
HC LSO SAGIT RIGID PANEL PREFAB
|
Facility
|
IP
|
$2,310.00
|
|
|
Service Code
|
CPT L0635
|
| Hospital Charge Code |
905350635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$2,079.00 |
| Rate for Payer: Adventist Health Commercial |
$462.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,785.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,164.24
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,848.00
|
| Rate for Payer: Cigna of CA HMO |
$1,617.00
|
| Rate for Payer: Cigna of CA PPO |
$1,617.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.00
|
| Rate for Payer: EPIC Health Plan Senior |
$924.00
|
| Rate for Payer: Galaxy Health WC |
$1,963.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,079.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,540.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,429.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.00
|
| Rate for Payer: Multiplan Commercial |
$1,732.50
|
| Rate for Payer: Networks By Design Commercial |
$1,501.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,963.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.94
|
| Rate for Payer: United Healthcare All Other HMO |
$843.84
|
| Rate for Payer: United Healthcare HMO Rider |
$825.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$756.52
|
|
|
HC LSO SAGITTAL RIGID PANEL CUS
|
Facility
|
OP
|
$3,047.00
|
|
|
Service Code
|
CPT L0636
|
| Hospital Charge Code |
905350636
|
|
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 |
$1,789.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.69
|
| Rate for Payer: Cash Price |
$1,675.85
|
| Rate for Payer: Cash Price |
$1,675.85
|
| 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: 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: Inland Empire Health Plan (IEHP) medi-cal |
$1,956.96
|
| Rate for Payer: InnovAge PACE Commercial |
$1,523.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,161.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,886.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,132.90
|
| Rate for Payer: Molina Healthcare of CA 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 SAGITTAL RIGID PANEL CUS
|
Facility
|
OP
|
$3,047.00
|
|
|
Service Code
|
CPT L0636
|
| Hospital Charge Code |
915350636
|
|
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 |
$1,789.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.69
|
| Rate for Payer: Cash Price |
$1,675.85
|
| Rate for Payer: Cash Price |
$1,675.85
|
| 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: 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: Inland Empire Health Plan (IEHP) medi-cal |
$1,956.96
|
| Rate for Payer: InnovAge PACE Commercial |
$1,523.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,161.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,886.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,132.90
|
| Rate for Payer: Molina Healthcare of CA 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 SAGITTAL RIGID PANEL CUS
|
Facility
|
IP
|
$3,047.00
|
|
|
Service Code
|
CPT L0636
|
| Hospital Charge Code |
915350636
|
|
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 |
$2,355.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.69
|
| Rate for Payer: Cash Price |
$1,675.85
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,160.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,886.09
|
| 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
|
|
