|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
IP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$554.20 |
| Max. Negotiated Rate |
$2,355.35 |
| Rate for Payer: Adventist Health Commercial |
$554.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,045.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,346.71
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.40
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,055.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,715.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.04
|
| Rate for Payer: Multiplan Commercial |
$2,216.80
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.25
|
| Rate for Payer: United Healthcare HMO Rider |
$990.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.50
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
OP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.31 |
| Max. Negotiated Rate |
$2,355.35 |
| Rate for Payer: Adventist Health Commercial |
$554.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,355.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,524.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,078.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,701.67
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,355.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,355.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,355.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.40
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,715.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,939.70
|
| Rate for Payer: Multiplan Commercial |
$2,216.80
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,662.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,662.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.25
|
| Rate for Payer: United Healthcare HMO Rider |
$990.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,355.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,355.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,355.35
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Adventist Health Commercial |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,274.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,623.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,069.20
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,361.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.00
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,361.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
915350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Adventist Health Commercial |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,274.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,623.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,069.20
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,361.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.00
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
915350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,361.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
OP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
915350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$675.52 |
| Rate for Payer: Adventist Health Commercial |
$325.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.31
|
| Rate for Payer: Blue Shield of California Commercial |
$586.51
|
| Rate for Payer: Blue Shield of California EPN |
$386.24
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$675.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$556.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$556.31
|
| Rate for Payer: Multiplan Commercial |
$635.78
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.52
|
| Rate for Payer: Vantage Medical Group Senior |
$675.52
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
IP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$158.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.74
|
| Rate for Payer: Multiplan Commercial |
$635.78
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
IP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
915350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$158.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.74
|
| Rate for Payer: Multiplan Commercial |
$635.78
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
OP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$675.52 |
| Rate for Payer: Adventist Health Commercial |
$325.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.31
|
| Rate for Payer: Blue Shield of California Commercial |
$586.51
|
| Rate for Payer: Blue Shield of California EPN |
$386.24
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$675.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$556.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$556.31
|
| Rate for Payer: Multiplan Commercial |
$635.78
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.52
|
| Rate for Payer: Vantage Medical Group Senior |
$675.52
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
IP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,975.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.16
|
| Rate for Payer: Multiplan Commercial |
$4,147.20
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
OP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,244.16 |
| Max. Negotiated Rate |
$4,406.40 |
| Rate for Payer: Adventist Health Commercial |
$2,125.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,851.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,888.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,002.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3,825.79
|
| Rate for Payer: Blue Shield of California EPN |
$2,519.42
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,406.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,628.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,628.80
|
| Rate for Payer: Multiplan Commercial |
$4,147.20
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,406.40
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
OP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
915368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,244.16 |
| Max. Negotiated Rate |
$4,406.40 |
| Rate for Payer: Adventist Health Commercial |
$2,125.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,851.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,888.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,002.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3,825.79
|
| Rate for Payer: Blue Shield of California EPN |
$2,519.42
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,406.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,628.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,628.80
|
| Rate for Payer: Multiplan Commercial |
$4,147.20
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,406.40
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
IP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
915368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,975.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.16
|
| Rate for Payer: Multiplan Commercial |
$4,147.20
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
|
|
HC CRANIAL SOCKS
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905380016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC CRANIAL SOCKS
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
915380016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.63
|
| Rate for Payer: Blue Shield of California Commercial |
$154.98
|
| Rate for Payer: Blue Shield of California EPN |
$102.06
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC CRANIAL SOCKS
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905380016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.63
|
| Rate for Payer: Blue Shield of California Commercial |
$154.98
|
| Rate for Payer: Blue Shield of California EPN |
$102.06
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC CRANIAL SOCKS
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
915380016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC C-REACTIVE PROTEIN
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$36.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.31
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC C-REACTIVE PROTEIN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$127.81 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.81
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Senior |
$12.95
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Senior |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC CREAM WOUND CARE ATRACTAIN 2OZ
|
Facility
|
IP
|
$27.96
|
|
| Hospital Charge Code |
901606201
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$23.77 |
| Rate for Payer: Adventist Health Commercial |
$5.59
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.18
|
| Rate for Payer: EPIC Health Plan Senior |
$11.18
|
| Rate for Payer: Galaxy Health WC |
$23.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$22.37
|
| Rate for Payer: Networks By Design Commercial |
$18.17
|
| Rate for Payer: Prime Health Services Commercial |
$23.77
|
|
|
HC CREAM WOUND CARE ATRACTAIN 2OZ
|
Facility
|
OP
|
$27.96
|
|
| Hospital Charge Code |
901606201
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$23.77 |
| Rate for Payer: Adventist Health Commercial |
$5.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.17
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cigna of CA HMO |
$17.89
|
| Rate for Payer: Cigna of CA PPO |
$20.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.18
|
| Rate for Payer: EPIC Health Plan Senior |
$11.18
|
| Rate for Payer: Galaxy Health WC |
$23.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.57
|
| Rate for Payer: Multiplan Commercial |
$22.37
|
| Rate for Payer: Networks By Design Commercial |
$18.17
|
| Rate for Payer: Prime Health Services Commercial |
$23.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.98
|
| Rate for Payer: United Healthcare All Other HMO |
$13.98
|
| Rate for Payer: United Healthcare HMO Rider |
$13.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.77
|
| Rate for Payer: Vantage Medical Group Senior |
$23.77
|
|
|
HC CREATINE KINASE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
900910222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
