|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
IP
|
$453.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$407.70 |
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Central Health Plan Commercial |
$362.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.20
|
| Rate for Payer: Galaxy Health WC |
$385.05
|
| Rate for Payer: Global Benefits Group Commercial |
$271.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$407.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.60
|
| Rate for Payer: Multiplan Commercial |
$339.75
|
| Rate for Payer: Networks By Design Commercial |
$294.45
|
| Rate for Payer: Prime Health Services Commercial |
$385.05
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
OP
|
$453.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$219.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.63
|
| Rate for Payer: BCBS Transplant Transplant |
$271.80
|
| Rate for Payer: Blue Shield of California Commercial |
$284.94
|
| Rate for Payer: Blue Shield of California EPN |
$221.52
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Central Health Plan Commercial |
$362.40
|
| Rate for Payer: Cigna of CA HMO |
$289.92
|
| Rate for Payer: Cigna of CA PPO |
$335.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$385.05
|
| Rate for Payer: Global Benefits Group Commercial |
$271.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$407.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$339.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$339.75
|
| Rate for Payer: Networks By Design Commercial |
$294.45
|
| Rate for Payer: Prime Health Services Commercial |
$385.05
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$271.80
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$546.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.80
|
| Rate for Payer: BCBS Transplant Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Caremore Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: IEHP medi-cal |
$102.53
|
| Rate for Payer: IEHP Medicare Advantage |
$62.14
|
| Rate for Payer: Innovage PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: Riverside University Health MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC LRNGSCPY, FLXBL W BX OR BXS
|
Facility
OP
|
$5,013.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
900500576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,007.80
|
| Rate for Payer: Caremore Medicare Advantage |
$2,120.62
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: Cigna of CA PPO |
$3,709.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,759.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,477.82
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Innovage PACE Commercial |
$3,180.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,841.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,247.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,007.80
|
| Rate for Payer: Riverside University Health MISP |
$2,332.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,506.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,506.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,506.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,506.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC LRNGSCPY, FLXBL W BX OR BXS
|
Facility
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
900500576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$4,511.70 |
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
|
|
HC LSO CORSET FRONT
|
Facility
IP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
905350972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Blue Shield of California EPN |
$217.87
|
| 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: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
|
|
HC LSO CORSET FRONT
|
Facility
OP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
905350972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$427.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$427.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$224.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.05
|
| Rate for Payer: BCBS Transplant Transplant |
$244.80
|
| Rate for Payer: Blue Shield of California Commercial |
$306.00
|
| Rate for Payer: Blue Shield of California EPN |
$221.95
|
| Rate for Payer: Cash Price |
$183.60
|
| 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: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$306.00
|
| Rate for Payer: IEHP medi-cal |
$142.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Riverside University Health MISP |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
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: Blue Shield of California EPN |
$1,627.10
|
| 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: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$609.40
|
| 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
|
|
|
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 |
$1,061.48 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,061.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,675.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,675.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,475.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,800.17
|
| Rate for Payer: BCBS Transplant Transplant |
$1,828.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,285.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,657.57
|
| Rate for Payer: Cash Price |
$1,371.15
|
| 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: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,285.25
|
| Rate for Payer: IEHP medi-cal |
$1,066.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.27
|
| 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 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 |
$1,523.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,523.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,523.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,523.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,589.95
|
|
|
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: Blue Shield of California EPN |
$226.95
|
| 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: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$283.48
|
| 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 |
$212.50
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
|
|
HC LSO, FLEXION CONTROL, CUSTOM
|
Facility
OP
|
$425.00
|
|
|
Service Code
|
CPT L0634
|
| Hospital Charge Code |
905350634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$2,147.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,147.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$361.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$233.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$233.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$205.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.09
|
| Rate for Payer: BCBS Transplant Transplant |
$255.00
|
| Rate for Payer: Blue Shield of California Commercial |
$318.75
|
| Rate for Payer: Blue Shield of California EPN |
$231.20
|
| Rate for Payer: Cash Price |
$191.25
|
| 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: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$318.75
|
| Rate for Payer: IEHP medi-cal |
$148.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$283.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.25
|
| 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 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 |
$212.50
|
| Rate for Payer: United Healthcare All Other HMO |
$212.50
|
| Rate for Payer: United Healthcare HMO Rider |
$212.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.50
|
| 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: Blue Shield of California EPN |
$245.64
|
| 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: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$306.82
|
| 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 |
$230.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
|
|
HC LSO FLEXION CONTROL PREFAB
|
Facility
OP
|
$460.00
|
|
|
Service Code
|
CPT L0633
|
| Hospital Charge Code |
905350633
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$1,137.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,137.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$253.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.77
|
| Rate for Payer: BCBS Transplant Transplant |
$276.00
|
| Rate for Payer: Blue Shield of California Commercial |
$345.00
|
| Rate for Payer: Blue Shield of California EPN |
$250.24
|
| 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: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$345.00
|
| Rate for Payer: IEHP medi-cal |
$161.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| 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 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 |
$230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC LSO FULL CORSET
|
Facility
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: Blue Shield of California EPN |
$143.11
|
| 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: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$178.76
|
| 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 |
$134.00
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC LSO FULL CORSET
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT L0976
|
| Hospital Charge Code |
905350976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$663.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$663.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.33
|
| Rate for Payer: BCBS Transplant Transplant |
$160.80
|
| Rate for Payer: Blue Shield of California Commercial |
$201.00
|
| Rate for Payer: Blue Shield of California EPN |
$145.79
|
| 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: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$201.00
|
| Rate for Payer: IEHP medi-cal |
$93.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.88
|
| 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 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 |
$134.00
|
| Rate for Payer: United Healthcare All Other HMO |
$134.00
|
| Rate for Payer: United Healthcare HMO Rider |
$134.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
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: Blue Shield of California EPN |
$149.52
|
| 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: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$56.00
|
| 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
|
|
|
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 |
$98.00 |
| Max. Negotiated Rate |
$642.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$642.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.42
|
| Rate for Payer: BCBS Transplant Transplant |
$168.00
|
| Rate for Payer: Blue Shield of California Commercial |
$210.00
|
| Rate for Payer: Blue Shield of California EPN |
$152.32
|
| 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: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$210.00
|
| Rate for Payer: IEHP medi-cal |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| 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 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 |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
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: Blue Shield of California EPN |
$1,185.48
|
| Rate for Payer: Cash Price |
$999.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$444.00
|
| 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
|
|
|
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 |
$777.00 |
| Max. Negotiated Rate |
$5,231.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,231.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,887.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,221.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,221.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,074.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,311.58
|
| Rate for Payer: BCBS Transplant Transplant |
$1,332.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,665.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,207.68
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| 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: EPIC Health Plan Commercial |
$888.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,665.00
|
| Rate for Payer: IEHP medi-cal |
$777.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.20
|
| 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 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 |
$1,110.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.00
|
| 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 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: Blue Shield of California EPN |
$1,087.76
|
| Rate for Payer: Cash Price |
$916.65
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$407.40
|
| 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
|
|
|
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 |
$712.95 |
| Max. Negotiated Rate |
$4,655.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,655.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,731.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,120.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,120.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$986.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,203.46
|
| Rate for Payer: BCBS Transplant Transplant |
$1,222.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,527.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,108.13
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: Cash Price |
$916.65
|
| 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: EPIC Health Plan Commercial |
$814.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,527.75
|
| Rate for Payer: IEHP medi-cal |
$712.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.17
|
| 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 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 |
$1,018.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,018.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,018.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,018.50
|
| 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
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: Blue Shield of California EPN |
$1,035.96
|
| Rate for Payer: Cash Price |
$873.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$388.00
|
| 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
|
|
|
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 |
$679.00 |
| Max. Negotiated Rate |
$4,072.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,072.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,649.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,067.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,067.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$939.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,146.15
|
| Rate for Payer: BCBS Transplant Transplant |
$1,164.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,455.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.36
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| 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: EPIC Health Plan Commercial |
$776.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,455.00
|
| Rate for Payer: IEHP medi-cal |
$679.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.40
|
| 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 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 |
$970.00
|
| Rate for Payer: United Healthcare All Other HMO |
$970.00
|
| Rate for Payer: United Healthcare HMO Rider |
$970.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$970.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,649.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,649.00
|
|
|
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: Blue Shield of California EPN |
$1,233.54
|
| Rate for Payer: Cash Price |
$1,039.50
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$462.00
|
| 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
|
|
