|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
915350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,109.25 |
| Rate for Payer: Adventist Health Commercial |
$535.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$717.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$978.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$755.86
|
| Rate for Payer: Blue Shield of California Commercial |
$963.09
|
| Rate for Payer: Blue Shield of California EPN |
$634.23
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,109.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Senior |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$587.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$807.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$913.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$913.50
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: Networks By Design Commercial |
$652.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.77
|
| Rate for Payer: United Healthcare All Other HMO |
$476.72
|
| Rate for Payer: United Healthcare HMO Rider |
$466.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,109.25
|
|
|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
905350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,109.25 |
| Rate for Payer: Adventist Health Commercial |
$535.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$717.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$978.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$755.86
|
| Rate for Payer: Blue Shield of California Commercial |
$963.09
|
| Rate for Payer: Blue Shield of California EPN |
$634.23
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,109.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Senior |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$587.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$807.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$913.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$913.50
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: Networks By Design Commercial |
$652.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.77
|
| Rate for Payer: United Healthcare All Other HMO |
$476.72
|
| Rate for Payer: United Healthcare HMO Rider |
$466.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,109.25
|
|
|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
905350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$261.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Senior |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$807.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: Networks By Design Commercial |
$652.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.77
|
| Rate for Payer: United Healthcare All Other HMO |
$476.72
|
| Rate for Payer: United Healthcare HMO Rider |
$466.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.39
|
|
|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
915350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$261.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Senior |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$807.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: Networks By Design Commercial |
$652.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.77
|
| Rate for Payer: United Healthcare All Other HMO |
$476.72
|
| Rate for Payer: United Healthcare HMO Rider |
$466.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.39
|
|
|
HC COLLAR PHILADELPHIA 3 1/4 MED
|
Facility
|
OP
|
$99.86
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$172.54 |
| Rate for Payer: Adventist Health Commercial |
$40.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.84
|
| Rate for Payer: Blue Shield of California Commercial |
$73.70
|
| Rate for Payer: Blue Shield of California EPN |
$48.53
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cigna of CA HMO |
$69.90
|
| Rate for Payer: Cigna of CA PPO |
$69.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.94
|
| Rate for Payer: EPIC Health Plan Senior |
$39.94
|
| Rate for Payer: Galaxy Health WC |
$84.88
|
| Rate for Payer: Global Benefits Group Commercial |
$59.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.90
|
| Rate for Payer: Multiplan Commercial |
$79.89
|
| Rate for Payer: Networks By Design Commercial |
$49.93
|
| Rate for Payer: Prime Health Services Commercial |
$84.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.48
|
| Rate for Payer: United Healthcare All Other HMO |
$36.48
|
| Rate for Payer: United Healthcare HMO Rider |
$35.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.88
|
| Rate for Payer: Vantage Medical Group Senior |
$84.88
|
|
|
HC COLLAR PHILADELPHIA 3 1/4 MED
|
Facility
|
IP
|
$99.86
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cigna of CA HMO |
$69.90
|
| Rate for Payer: Cigna of CA PPO |
$69.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.94
|
| Rate for Payer: EPIC Health Plan Senior |
$39.94
|
| Rate for Payer: Galaxy Health WC |
$84.88
|
| Rate for Payer: Global Benefits Group Commercial |
$59.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.97
|
| Rate for Payer: Multiplan Commercial |
$79.89
|
| Rate for Payer: Networks By Design Commercial |
$49.93
|
| Rate for Payer: Prime Health Services Commercial |
$84.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.48
|
| Rate for Payer: United Healthcare All Other HMO |
$36.48
|
| Rate for Payer: United Healthcare HMO Rider |
$35.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.70
|
|
|
HC COLLAR PHILADELPHIA 4 1/4 MED
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$79.95
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
|
|
HC COLLAR PHILADELPHIA 4 1/4 MED
|
Facility
|
OP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$172.54 |
| Rate for Payer: Adventist Health Commercial |
$40.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.89
|
| Rate for Payer: Blue Shield of California Commercial |
$73.76
|
| Rate for Payer: Blue Shield of California EPN |
$48.57
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.96
|
| Rate for Payer: Multiplan Commercial |
$79.95
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.95
|
| Rate for Payer: Vantage Medical Group Senior |
$84.95
|
|
|
HC COLLAR PHILADELPHIA 5 1/4 MED
|
Facility
|
OP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$172.54 |
| Rate for Payer: Adventist Health Commercial |
$40.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.89
|
| Rate for Payer: Blue Shield of California Commercial |
$73.76
|
| Rate for Payer: Blue Shield of California EPN |
$48.57
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.96
|
| Rate for Payer: Multiplan Commercial |
$79.95
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.95
|
| Rate for Payer: Vantage Medical Group Senior |
$84.95
|
|
|
HC COLLAR PHILADELPHIA 5 1/4 MED
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$79.95
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
|
|
HC COLLAR PLASTIC FLEXIBLE MOLDED
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT L0130
|
| Hospital Charge Code |
905350130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$220.15 |
| Rate for Payer: Adventist Health Commercial |
$106.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.01
|
| Rate for Payer: Blue Shield of California Commercial |
$191.14
|
| Rate for Payer: Blue Shield of California EPN |
$125.87
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO |
$181.30
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$129.50
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.20
|
| Rate for Payer: United Healthcare All Other HMO |
$94.61
|
| Rate for Payer: United Healthcare HMO Rider |
$92.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC COLLAR PLASTIC FLEXIBLE MOLDED
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT L0130
|
| Hospital Charge Code |
915350130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO |
$181.30
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$129.50
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.20
|
| Rate for Payer: United Healthcare All Other HMO |
$94.61
|
| Rate for Payer: United Healthcare HMO Rider |
$92.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.82
|
|
|
HC COLLAR PLASTIC FLEXIBLE MOLDED
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT L0130
|
| Hospital Charge Code |
915350130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$220.15 |
| Rate for Payer: Adventist Health Commercial |
$106.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.01
|
| Rate for Payer: Blue Shield of California Commercial |
$191.14
|
| Rate for Payer: Blue Shield of California EPN |
$125.87
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO |
$181.30
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$129.50
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.20
|
| Rate for Payer: United Healthcare All Other HMO |
$94.61
|
| Rate for Payer: United Healthcare HMO Rider |
$92.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC COLLAR PLASTIC FLEXIBLE MOLDED
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT L0130
|
| Hospital Charge Code |
905350130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO |
$181.30
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$129.50
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.20
|
| Rate for Payer: United Healthcare All Other HMO |
$94.61
|
| Rate for Payer: United Healthcare HMO Rider |
$92.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.82
|
|
|
HC COLLAR PLASTIC SEMI-RIGID
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT L0140
|
| Hospital Charge Code |
905350140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna of CA HMO |
$183.40
|
| Rate for Payer: Cigna of CA PPO |
$183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.88
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Networks By Design Commercial |
$131.00
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.33
|
| Rate for Payer: United Healthcare All Other HMO |
$95.71
|
| Rate for Payer: United Healthcare HMO Rider |
$93.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.81
|
|
|
HC COLLAR PLASTIC SEMI-RIGID
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT L0140
|
| Hospital Charge Code |
915350140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna of CA HMO |
$183.40
|
| Rate for Payer: Cigna of CA PPO |
$183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.88
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Networks By Design Commercial |
$131.00
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.33
|
| Rate for Payer: United Healthcare All Other HMO |
$95.71
|
| Rate for Payer: United Healthcare HMO Rider |
$93.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.81
|
|
|
HC COLLAR PLASTIC SEMI-RIGID
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT L0140
|
| Hospital Charge Code |
915350140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: Adventist Health Commercial |
$107.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.75
|
| Rate for Payer: Blue Shield of California Commercial |
$193.36
|
| Rate for Payer: Blue Shield of California EPN |
$127.33
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna of CA HMO |
$183.40
|
| Rate for Payer: Cigna of CA PPO |
$183.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$222.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$183.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Networks By Design Commercial |
$131.00
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.33
|
| Rate for Payer: United Healthcare All Other HMO |
$95.71
|
| Rate for Payer: United Healthcare HMO Rider |
$93.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.70
|
| Rate for Payer: Vantage Medical Group Senior |
$222.70
|
|
|
HC COLLAR PLASTIC SEMI-RIGID
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT L0140
|
| Hospital Charge Code |
905350140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: Adventist Health Commercial |
$107.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.75
|
| Rate for Payer: Blue Shield of California Commercial |
$193.36
|
| Rate for Payer: Blue Shield of California EPN |
$127.33
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna of CA HMO |
$183.40
|
| Rate for Payer: Cigna of CA PPO |
$183.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$222.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$183.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Networks By Design Commercial |
$131.00
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.33
|
| Rate for Payer: United Healthcare All Other HMO |
$95.71
|
| Rate for Payer: United Healthcare HMO Rider |
$93.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.70
|
| Rate for Payer: Vantage Medical Group Senior |
$222.70
|
|
|
HC COLLAR SEMI-RIGID 2-PIECE FOAM
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
905350172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna of CA HMO |
$219.80
|
| Rate for Payer: Cigna of CA PPO |
$219.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Networks By Design Commercial |
$157.00
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.84
|
| Rate for Payer: United Healthcare All Other HMO |
$114.70
|
| Rate for Payer: United Healthcare HMO Rider |
$112.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.83
|
|
|
HC COLLAR SEMI-RIGID 2-PIECE FOAM
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
905350172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.36 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: Adventist Health Commercial |
$128.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$266.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$235.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$231.73
|
| Rate for Payer: Blue Shield of California EPN |
$152.60
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna of CA HMO |
$219.80
|
| Rate for Payer: Cigna of CA PPO |
$219.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$266.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$266.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$266.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.80
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Networks By Design Commercial |
$157.00
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.84
|
| Rate for Payer: United Healthcare All Other HMO |
$114.70
|
| Rate for Payer: United Healthcare HMO Rider |
$112.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$266.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$266.90
|
| Rate for Payer: Vantage Medical Group Senior |
$266.90
|
|
|
HC COLLAR SEMI-RIGID 2-PIECE FOAM
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
915350172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.36 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: Adventist Health Commercial |
$128.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$266.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$235.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$231.73
|
| Rate for Payer: Blue Shield of California EPN |
$152.60
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna of CA HMO |
$219.80
|
| Rate for Payer: Cigna of CA PPO |
$219.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$266.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$266.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$266.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.80
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Networks By Design Commercial |
$157.00
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.84
|
| Rate for Payer: United Healthcare All Other HMO |
$114.70
|
| Rate for Payer: United Healthcare HMO Rider |
$112.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$266.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$266.90
|
| Rate for Payer: Vantage Medical Group Senior |
$266.90
|
|
|
HC COLLAR SEMI-RIGID 2-PIECE FOAM
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
915350172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna of CA HMO |
$219.80
|
| Rate for Payer: Cigna of CA PPO |
$219.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Networks By Design Commercial |
$157.00
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.84
|
| Rate for Payer: United Healthcare All Other HMO |
$114.70
|
| Rate for Payer: United Healthcare HMO Rider |
$112.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.83
|
|
|
HC COLLAR SEMI-RIGID WIRE FRAME
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT L0160
|
| Hospital Charge Code |
915350160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna of CA HMO |
$339.50
|
| Rate for Payer: Cigna of CA PPO |
$339.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Senior |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$242.50
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.02
|
| Rate for Payer: United Healthcare All Other HMO |
$177.17
|
| Rate for Payer: United Healthcare HMO Rider |
$173.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.84
|
|
|
HC COLLAR SEMI-RIGID WIRE FRAME
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT L0160
|
| Hospital Charge Code |
905350160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: Adventist Health Commercial |
$198.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$412.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$266.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.91
|
| Rate for Payer: Blue Shield of California Commercial |
$357.93
|
| Rate for Payer: Blue Shield of California EPN |
$235.71
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna of CA HMO |
$339.50
|
| Rate for Payer: Cigna of CA PPO |
$339.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$412.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$412.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Senior |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$339.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$339.50
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$242.50
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.02
|
| Rate for Payer: United Healthcare All Other HMO |
$177.17
|
| Rate for Payer: United Healthcare HMO Rider |
$173.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$412.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.25
|
| Rate for Payer: Vantage Medical Group Senior |
$412.25
|
|
|
HC COLLAR SEMI-RIGID WIRE FRAME
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT L0160
|
| Hospital Charge Code |
905350160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna of CA HMO |
$339.50
|
| Rate for Payer: Cigna of CA PPO |
$339.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Senior |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$242.50
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.02
|
| Rate for Payer: United Healthcare All Other HMO |
$177.17
|
| Rate for Payer: United Healthcare HMO Rider |
$173.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.84
|
|
