|
HC COLLAR MIAMI J PEDS P1
|
Facility
|
OP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605407
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.95 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$87.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.97
|
| Rate for Payer: Blue Shield of California Commercial |
$156.68
|
| Rate for Payer: Blue Shield of California EPN |
$103.18
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.62
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.46
|
| Rate for Payer: Vantage Medical Group Senior |
$180.46
|
|
|
HC COLLAR MIAMI J PEDS P2
|
Facility
|
OP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605408
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.95 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$87.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.97
|
| Rate for Payer: Blue Shield of California Commercial |
$156.68
|
| Rate for Payer: Blue Shield of California EPN |
$103.18
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.62
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.46
|
| Rate for Payer: Vantage Medical Group Senior |
$180.46
|
|
|
HC COLLAR MIAMI J PEDS P2
|
Facility
|
IP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605408
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
|
|
HC COLLAR MIAMI J PEDS P3
|
Facility
|
IP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605409
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
|
|
HC COLLAR MIAMI J PEDS P3
|
Facility
|
OP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605409
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.95 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$87.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.97
|
| Rate for Payer: Blue Shield of California Commercial |
$156.68
|
| Rate for Payer: Blue Shield of California EPN |
$103.18
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.62
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.46
|
| Rate for Payer: Vantage Medical Group Senior |
$180.46
|
|
|
HC COLLAR MIAMI J PEDS PO
|
Facility
|
IP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605406
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
|
|
HC COLLAR MIAMI J PEDS PO
|
Facility
|
OP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605406
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.95 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$87.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.97
|
| Rate for Payer: Blue Shield of California Commercial |
$156.68
|
| Rate for Payer: Blue Shield of California EPN |
$103.18
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.62
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.46
|
| Rate for Payer: Vantage Medical Group Senior |
$180.46
|
|
|
HC COLLAR MIAMI J REPLACEMENT PAD
|
Facility
|
OP
|
$160.44
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901698555
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$136.37 |
| Rate for Payer: Adventist Health Commercial |
$65.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.93
|
| Rate for Payer: Blue Shield of California Commercial |
$118.40
|
| Rate for Payer: Blue Shield of California EPN |
$77.97
|
| Rate for Payer: Cash Price |
$72.20
|
| Rate for Payer: Cigna of CA HMO |
$112.31
|
| Rate for Payer: Cigna of CA PPO |
$112.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.18
|
| Rate for Payer: EPIC Health Plan Senior |
$64.18
|
| Rate for Payer: Galaxy Health WC |
$136.37
|
| Rate for Payer: Global Benefits Group Commercial |
$96.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.31
|
| Rate for Payer: Multiplan Commercial |
$128.35
|
| Rate for Payer: Networks By Design Commercial |
$80.22
|
| Rate for Payer: Prime Health Services Commercial |
$136.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.21
|
| Rate for Payer: United Healthcare All Other HMO |
$58.61
|
| Rate for Payer: United Healthcare HMO Rider |
$57.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.37
|
| Rate for Payer: Vantage Medical Group Senior |
$136.37
|
|
|
HC COLLAR MIAMI J REPLACEMENT PAD
|
Facility
|
IP
|
$160.44
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901698555
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$72.20
|
| Rate for Payer: Cash Price |
$72.20
|
| Rate for Payer: Cigna of CA HMO |
$112.31
|
| Rate for Payer: Cigna of CA PPO |
$112.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.18
|
| Rate for Payer: EPIC Health Plan Senior |
$64.18
|
| Rate for Payer: Galaxy Health WC |
$136.37
|
| Rate for Payer: Global Benefits Group Commercial |
$96.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.51
|
| Rate for Payer: Multiplan Commercial |
$128.35
|
| Rate for Payer: Networks By Design Commercial |
$80.22
|
| Rate for Payer: Prime Health Services Commercial |
$136.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.21
|
| Rate for Payer: United Healthcare All Other HMO |
$58.61
|
| Rate for Payer: United Healthcare HMO Rider |
$57.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.54
|
|
|
HC COLLAR MIAMI J SM
|
Facility
|
IP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Senior |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.13
|
| Rate for Payer: Multiplan Commercial |
$153.78
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.14
|
| Rate for Payer: United Healthcare All Other HMO |
$70.22
|
| Rate for Payer: United Healthcare HMO Rider |
$68.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.95
|
|
|
HC COLLAR MIAMI J SM
|
Facility
|
OP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.13 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$78.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.33
|
| Rate for Payer: Blue Shield of California Commercial |
$141.86
|
| Rate for Payer: Blue Shield of California EPN |
$93.42
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Senior |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.55
|
| Rate for Payer: Multiplan Commercial |
$153.78
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.14
|
| Rate for Payer: United Healthcare All Other HMO |
$70.22
|
| Rate for Payer: United Healthcare HMO Rider |
$68.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.39
|
| Rate for Payer: Vantage Medical Group Senior |
$163.39
|
|
|
HC COLLAR MIAMI J STOUT
|
Facility
|
IP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
|
|
HC COLLAR MIAMI J STOUT
|
Facility
|
OP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.95 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$87.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.97
|
| Rate for Payer: Blue Shield of California Commercial |
$156.68
|
| Rate for Payer: Blue Shield of California EPN |
$103.18
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.62
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.46
|
| Rate for Payer: Vantage Medical Group Senior |
$180.46
|
|
|
HC COLLAR MIAMI J SUPER SHORT
|
Facility
|
OP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.95 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$87.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.97
|
| Rate for Payer: Blue Shield of California Commercial |
$156.68
|
| Rate for Payer: Blue Shield of California EPN |
$103.18
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.62
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.46
|
| Rate for Payer: Vantage Medical Group Senior |
$180.46
|
|
|
HC COLLAR MIAMI J SUPER SHORT
|
Facility
|
IP
|
$212.31
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$148.62
|
| Rate for Payer: Cigna of CA PPO |
$148.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.92
|
| Rate for Payer: EPIC Health Plan Senior |
$84.92
|
| Rate for Payer: Galaxy Health WC |
$180.46
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.95
|
| Rate for Payer: Multiplan Commercial |
$169.85
|
| Rate for Payer: Networks By Design Commercial |
$106.16
|
| Rate for Payer: Prime Health Services Commercial |
$180.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Other HMO |
$77.56
|
| Rate for Payer: United Healthcare HMO Rider |
$75.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.53
|
|
|
HC COLLAR MIAMI J UNIVERSAL
|
Facility
|
IP
|
$266.70
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698554
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$120.02
|
| Rate for Payer: Cash Price |
$120.02
|
| Rate for Payer: Cigna of CA HMO |
$186.69
|
| Rate for Payer: Cigna of CA PPO |
$186.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.68
|
| Rate for Payer: EPIC Health Plan Senior |
$106.68
|
| Rate for Payer: Galaxy Health WC |
$226.69
|
| Rate for Payer: Global Benefits Group Commercial |
$160.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.01
|
| Rate for Payer: Multiplan Commercial |
$213.36
|
| Rate for Payer: Networks By Design Commercial |
$133.35
|
| Rate for Payer: Prime Health Services Commercial |
$226.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.09
|
| Rate for Payer: United Healthcare All Other HMO |
$97.43
|
| Rate for Payer: United Healthcare HMO Rider |
$95.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.34
|
|
|
HC COLLAR MIAMI J UNIVERSAL
|
Facility
|
OP
|
$266.70
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698554
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.01 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$109.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.47
|
| Rate for Payer: Blue Shield of California Commercial |
$196.82
|
| Rate for Payer: Blue Shield of California EPN |
$129.62
|
| Rate for Payer: Cash Price |
$120.02
|
| Rate for Payer: Cash Price |
$120.02
|
| Rate for Payer: Cigna of CA HMO |
$186.69
|
| Rate for Payer: Cigna of CA PPO |
$186.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.68
|
| Rate for Payer: EPIC Health Plan Senior |
$106.68
|
| Rate for Payer: Galaxy Health WC |
$226.69
|
| Rate for Payer: Global Benefits Group Commercial |
$160.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.69
|
| Rate for Payer: Multiplan Commercial |
$213.36
|
| Rate for Payer: Networks By Design Commercial |
$133.35
|
| Rate for Payer: Prime Health Services Commercial |
$226.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.09
|
| Rate for Payer: United Healthcare All Other HMO |
$97.43
|
| Rate for Payer: United Healthcare HMO Rider |
$95.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.69
|
| Rate for Payer: Vantage Medical Group Senior |
$226.69
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
905350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$163.00
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.35
|
| Rate for Payer: United Healthcare All Other HMO |
$119.09
|
| Rate for Payer: United Healthcare HMO Rider |
$116.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.77
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
905350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$133.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$244.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.82
|
| Rate for Payer: Blue Shield of California Commercial |
$240.59
|
| Rate for Payer: Blue Shield of California EPN |
$158.44
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$163.00
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.35
|
| Rate for Payer: United Healthcare All Other HMO |
$119.09
|
| Rate for Payer: United Healthcare HMO Rider |
$116.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.10
|
| Rate for Payer: Vantage Medical Group Senior |
$277.10
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
915350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$133.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$244.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.82
|
| Rate for Payer: Blue Shield of California Commercial |
$240.59
|
| Rate for Payer: Blue Shield of California EPN |
$158.44
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$163.00
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.35
|
| Rate for Payer: United Healthcare All Other HMO |
$119.09
|
| Rate for Payer: United Healthcare HMO Rider |
$116.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.10
|
| Rate for Payer: Vantage Medical Group Senior |
$277.10
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
915350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$163.00
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.35
|
| Rate for Payer: United Healthcare All Other HMO |
$119.09
|
| Rate for Payer: United Healthcare HMO Rider |
$116.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.77
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
915350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$1,542.75 |
| Rate for Payer: Adventist Health Commercial |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,361.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,051.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.47
|
| Rate for Payer: Blue Shield of California EPN |
$882.09
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,542.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Senior |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,123.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,270.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,270.50
|
| Rate for Payer: Multiplan Commercial |
$1,452.00
|
| Rate for Payer: Networks By Design Commercial |
$907.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,089.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,089.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$681.17
|
| Rate for Payer: United Healthcare All Other HMO |
$663.02
|
| Rate for Payer: United Healthcare HMO Rider |
$648.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.75
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
905350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$1,542.75 |
| Rate for Payer: Adventist Health Commercial |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,361.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,051.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.47
|
| Rate for Payer: Blue Shield of California EPN |
$882.09
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,542.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Senior |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,123.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,270.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,270.50
|
| Rate for Payer: Multiplan Commercial |
$1,452.00
|
| Rate for Payer: Networks By Design Commercial |
$907.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,089.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,089.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$681.17
|
| Rate for Payer: United Healthcare All Other HMO |
$663.02
|
| Rate for Payer: United Healthcare HMO Rider |
$648.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.75
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
IP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
915350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$363.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Senior |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,123.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.60
|
| Rate for Payer: Multiplan Commercial |
$1,452.00
|
| Rate for Payer: Networks By Design Commercial |
$907.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$681.17
|
| Rate for Payer: United Healthcare All Other HMO |
$663.02
|
| Rate for Payer: United Healthcare HMO Rider |
$648.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.41
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
IP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
905350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$363.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Senior |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,123.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.60
|
| Rate for Payer: Multiplan Commercial |
$1,452.00
|
| Rate for Payer: Networks By Design Commercial |
$907.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$681.17
|
| Rate for Payer: United Healthcare All Other HMO |
$663.02
|
| Rate for Payer: United Healthcare HMO Rider |
$648.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.41
|
|
