|
HC COLLAR CERVICAL LG 4.0 X 20
|
Facility
|
IP
|
$43.30
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$28.14
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
|
|
HC COLLAR CERVICAL MED 4.0 X 18
|
Facility
|
OP
|
$43.30
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.21
|
| Rate for Payer: Blue Shield of California Commercial |
$33.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.95
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.31
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.80
|
| Rate for Payer: Vantage Medical Group Senior |
$36.80
|
|
|
HC COLLAR CERVICAL MED 4.0 X 18
|
Facility
|
IP
|
$43.30
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$28.14
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
|
|
HC COLLAR CERVICAL MOLDED TO PT
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT L0170
|
| Hospital Charge Code |
905350170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,168.75 |
| Rate for Payer: Adventist Health Commercial |
$563.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,031.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$832.29
|
| Rate for Payer: Blue Shield of California Commercial |
$697.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,057.38
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$962.50
|
| Rate for Payer: Cigna of CA PPO |
$962.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,168.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,168.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$962.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$550.00
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$600.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$873.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$679.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$811.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$962.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$962.50
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$687.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.04
|
| Rate for Payer: United Healthcare All Other HMO |
$502.29
|
| Rate for Payer: United Healthcare HMO Rider |
$491.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,168.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,168.75
|
|
|
HC COLLAR CERVICAL MOLDED TO PT
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT L0170
|
| Hospital Charge Code |
915350170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$962.50
|
| Rate for Payer: Cigna of CA PPO |
$962.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$962.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$550.00
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$873.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$811.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$893.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.04
|
| Rate for Payer: United Healthcare All Other HMO |
$502.29
|
| Rate for Payer: United Healthcare HMO Rider |
$491.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.31
|
|
|
HC COLLAR CERVICAL MOLDED TO PT
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT L0170
|
| Hospital Charge Code |
915350170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,168.75 |
| Rate for Payer: Adventist Health Commercial |
$563.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,031.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$832.29
|
| Rate for Payer: Blue Shield of California Commercial |
$697.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,057.38
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$962.50
|
| Rate for Payer: Cigna of CA PPO |
$962.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,168.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,168.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$962.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$550.00
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$600.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$873.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$679.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$811.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$962.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$962.50
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$687.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.04
|
| Rate for Payer: United Healthcare All Other HMO |
$502.29
|
| Rate for Payer: United Healthcare HMO Rider |
$491.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,168.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,168.75
|
|
|
HC COLLAR CERVICAL MOLDED TO PT
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT L0170
|
| Hospital Charge Code |
905350170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$962.50
|
| Rate for Payer: Cigna of CA PPO |
$962.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$962.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$550.00
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$873.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$811.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$893.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.04
|
| Rate for Payer: United Healthcare All Other HMO |
$502.29
|
| Rate for Payer: United Healthcare HMO Rider |
$491.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.31
|
|
|
HC COLLAR CERVICAL SM 3.5 X 16
|
Facility
|
OP
|
$43.30
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606821
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.21
|
| Rate for Payer: Blue Shield of California Commercial |
$33.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.95
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.31
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.80
|
| Rate for Payer: Vantage Medical Group Senior |
$36.80
|
|
|
HC COLLAR CERVICAL SM 3.5 X 16
|
Facility
|
IP
|
$43.30
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606821
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$28.14
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
|
|
HC COLLAR CERVICAL SM XFIRM
|
Facility
|
IP
|
$79.87
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901698958
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Cigna of CA HMO |
$55.91
|
| Rate for Payer: Cigna of CA PPO |
$55.91
|
| Rate for Payer: Adventist Health Commercial |
$15.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.95
|
| Rate for Payer: EPIC Health Plan Senior |
$31.95
|
| Rate for Payer: Galaxy Health WC |
$67.89
|
| Rate for Payer: Global Benefits Group Commercial |
$47.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.17
|
| Rate for Payer: Multiplan Commercial |
$63.90
|
| Rate for Payer: Networks By Design Commercial |
$51.92
|
| Rate for Payer: Prime Health Services Commercial |
$67.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.98
|
| Rate for Payer: United Healthcare All Other HMO |
$29.18
|
| Rate for Payer: United Healthcare HMO Rider |
$28.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.16
|
|
|
HC COLLAR CERVICAL SM XFIRM
|
Facility
|
OP
|
$79.87
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901698958
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Adventist Health Commercial |
$32.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.35
|
| Rate for Payer: Blue Shield of California Commercial |
$61.42
|
| Rate for Payer: Blue Shield of California Commercial |
$40.49
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Cigna of CA HMO |
$55.91
|
| Rate for Payer: Cigna of CA PPO |
$55.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.95
|
| Rate for Payer: EPIC Health Plan Senior |
$31.95
|
| Rate for Payer: Galaxy Health WC |
$67.89
|
| Rate for Payer: Global Benefits Group Commercial |
$47.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.91
|
| Rate for Payer: Multiplan Commercial |
$63.90
|
| Rate for Payer: Networks By Design Commercial |
$39.94
|
| Rate for Payer: Prime Health Services Commercial |
$67.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.98
|
| Rate for Payer: United Healthcare All Other HMO |
$29.18
|
| Rate for Payer: United Healthcare HMO Rider |
$28.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.89
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC COLLAR CERVICAL X-LG 4.0 X 22
|
Facility
|
IP
|
$43.30
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$28.14
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
|
|
HC COLLAR CERVICAL X-LG 4.0 X 22
|
Facility
|
OP
|
$43.30
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.21
|
| Rate for Payer: Blue Shield of California Commercial |
$33.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.95
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.31
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.80
|
| Rate for Payer: Vantage Medical Group Senior |
$36.80
|
|
|
HC COLLAR FLEXIBLE FOAM
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
905350120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO |
$47.60
|
| Rate for Payer: Cigna of CA PPO |
$47.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.52
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.27
|
|
|
HC COLLAR FLEXIBLE FOAM
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
915350120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO |
$47.60
|
| Rate for Payer: Cigna of CA PPO |
$47.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.52
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.27
|
|
|
HC COLLAR FLEXIBLE FOAM
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
905350120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Adventist Health Commercial |
$27.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.16
|
| Rate for Payer: Blue Shield of California Commercial |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$34.48
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO |
$47.60
|
| Rate for Payer: Cigna of CA PPO |
$47.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.52
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.80
|
| Rate for Payer: Vantage Medical Group Senior |
$57.80
|
|
|
HC COLLAR FLEXIBLE FOAM
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
915350120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Adventist Health Commercial |
$27.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.16
|
| Rate for Payer: Blue Shield of California Commercial |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$34.48
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO |
$47.60
|
| Rate for Payer: Cigna of CA PPO |
$47.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.52
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.80
|
| Rate for Payer: Vantage Medical Group Senior |
$57.80
|
|
|
HC COLLAR MIAMI J ACCESSORY
|
Facility
|
IP
|
$591.42
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.28 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$118.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$266.14
|
| Rate for Payer: Cash Price |
$266.14
|
| Rate for Payer: Cigna of CA HMO |
$413.99
|
| Rate for Payer: Cigna of CA PPO |
$413.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$413.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.57
|
| Rate for Payer: EPIC Health Plan Senior |
$236.57
|
| Rate for Payer: Galaxy Health WC |
$502.71
|
| Rate for Payer: Global Benefits Group Commercial |
$354.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$348.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.94
|
| Rate for Payer: Multiplan Commercial |
$473.14
|
| Rate for Payer: Networks By Design Commercial |
$384.42
|
| Rate for Payer: Prime Health Services Commercial |
$502.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.96
|
| Rate for Payer: United Healthcare All Other HMO |
$216.05
|
| Rate for Payer: United Healthcare HMO Rider |
$211.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.69
|
|
|
HC COLLAR MIAMI J ACCESSORY
|
Facility
|
OP
|
$591.42
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.94 |
| Max. Negotiated Rate |
$502.71 |
| Rate for Payer: Cigna of CA PPO |
$413.99
|
| Rate for Payer: Adventist Health Commercial |
$242.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.99
|
| Rate for Payer: Blue Shield of California Commercial |
$454.80
|
| Rate for Payer: Blue Shield of California Commercial |
$299.85
|
| Rate for Payer: Cash Price |
$266.14
|
| Rate for Payer: Cash Price |
$266.14
|
| Rate for Payer: Cigna of CA HMO |
$413.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$502.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$413.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.57
|
| Rate for Payer: EPIC Health Plan Senior |
$236.57
|
| Rate for Payer: Galaxy Health WC |
$502.71
|
| Rate for Payer: Global Benefits Group Commercial |
$354.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$348.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.99
|
| Rate for Payer: Multiplan Commercial |
$473.14
|
| Rate for Payer: Networks By Design Commercial |
$295.71
|
| Rate for Payer: Prime Health Services Commercial |
$502.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.96
|
| Rate for Payer: United Healthcare All Other HMO |
$216.05
|
| Rate for Payer: United Healthcare HMO Rider |
$211.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$502.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.71
|
| Rate for Payer: Vantage Medical Group Senior |
$502.71
|
|
|
HC COLLAR MIAMI J LG
|
Facility
|
OP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.13 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$78.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.35
|
| Rate for Payer: Blue Shield of California Commercial |
$97.46
|
| Rate for Payer: Blue Shield of California Commercial |
$147.82
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Senior |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.55
|
| Rate for Payer: Multiplan Commercial |
$153.78
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.14
|
| Rate for Payer: United Healthcare All Other HMO |
$70.22
|
| Rate for Payer: United Healthcare HMO Rider |
$68.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.39
|
| Rate for Payer: Vantage Medical Group Senior |
$163.39
|
|
|
HC COLLAR MIAMI J LG
|
Facility
|
IP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$38.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Senior |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.13
|
| Rate for Payer: Multiplan Commercial |
$153.78
|
| Rate for Payer: Networks By Design Commercial |
$124.94
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.14
|
| Rate for Payer: United Healthcare All Other HMO |
$70.22
|
| Rate for Payer: United Healthcare HMO Rider |
$68.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.95
|
|
|
HC COLLAR MIAMI J MED
|
Facility
|
OP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.13 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$78.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.35
|
| Rate for Payer: Blue Shield of California Commercial |
$97.46
|
| Rate for Payer: Blue Shield of California Commercial |
$147.82
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Senior |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.55
|
| Rate for Payer: Multiplan Commercial |
$153.78
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.14
|
| Rate for Payer: United Healthcare All Other HMO |
$70.22
|
| Rate for Payer: United Healthcare HMO Rider |
$68.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.39
|
| Rate for Payer: Vantage Medical Group Senior |
$163.39
|
|
|
HC COLLAR MIAMI J MED
|
Facility
|
IP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$38.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Senior |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.13
|
| Rate for Payer: Multiplan Commercial |
$153.78
|
| Rate for Payer: Networks By Design Commercial |
$124.94
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.14
|
| Rate for Payer: United Healthcare All Other HMO |
$70.22
|
| Rate for Payer: United Healthcare HMO Rider |
$68.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.95
|
|
|
HC COLLAR MIAMI J OCCIAN BACK JR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698297
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC COLLAR MIAMI J OCCIAN BACK JR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698297
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
