|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
905368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
905368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$437.29 |
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.96
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
915350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,280.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,385.20
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cigna of CA HMO |
$2,378.88
|
| Rate for Payer: Cigna of CA PPO |
$2,750.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,601.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
905350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
905350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,280.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,385.20
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cigna of CA HMO |
$2,378.88
|
| Rate for Payer: Cigna of CA PPO |
$2,750.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,601.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
915350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
915368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
905368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
915368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$437.29 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.96
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
905368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$437.29 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.96
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
|
HC HELMET SOFT SHELL 2X-SM TAN
|
Facility
|
IP
|
$518.23
|
|
| Hospital Charge Code |
901698208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.65 |
| Max. Negotiated Rate |
$440.50 |
| Rate for Payer: Adventist Health Commercial |
$103.65
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.29
|
| Rate for Payer: EPIC Health Plan Senior |
$207.29
|
| Rate for Payer: Galaxy Health WC |
$440.50
|
| Rate for Payer: Global Benefits Group Commercial |
$310.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.38
|
| Rate for Payer: Multiplan Commercial |
$414.58
|
| Rate for Payer: Networks By Design Commercial |
$336.85
|
| Rate for Payer: Prime Health Services Commercial |
$440.50
|
|
|
HC HELMET SOFT SHELL 2X-SM TAN
|
Facility
|
OP
|
$518.23
|
|
| Hospital Charge Code |
901698208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.65 |
| Max. Negotiated Rate |
$440.50 |
| Rate for Payer: Adventist Health Commercial |
$103.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$440.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$285.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.55
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cigna of CA HMO |
$331.67
|
| Rate for Payer: Cigna of CA PPO |
$383.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$440.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$440.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.29
|
| Rate for Payer: EPIC Health Plan Senior |
$207.29
|
| Rate for Payer: Galaxy Health WC |
$440.50
|
| Rate for Payer: Global Benefits Group Commercial |
$310.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$362.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$362.76
|
| Rate for Payer: Multiplan Commercial |
$414.58
|
| Rate for Payer: Networks By Design Commercial |
$336.85
|
| Rate for Payer: Prime Health Services Commercial |
$440.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.12
|
| Rate for Payer: United Healthcare All Other HMO |
$259.12
|
| Rate for Payer: United Healthcare HMO Rider |
$259.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$440.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.50
|
| Rate for Payer: Vantage Medical Group Senior |
$440.50
|
|
|
HC HELMET SOFT SHELL LARGE
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901604758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL LARGE
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901604758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.54
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$351.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL MED, TAN
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901698207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.54
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$351.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL MED, TAN
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901698207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL SMALL,TAN
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901698206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL SMALL,TAN
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901698206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.54
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$351.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL X-LRG TAN
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.19
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC HELMET SOFT SHELL X-LRG TAN
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC HELMET SOFT SHELL X-SMALL TAN
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901698205
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL X-SMALL TAN
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901698205
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.54
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$351.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL XXLG
|
Facility
|
OP
|
$393.99
|
|
| Hospital Charge Code |
901692013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$334.89 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.82
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna of CA HMO |
$252.15
|
| Rate for Payer: Cigna of CA PPO |
$291.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.89
|
| Rate for Payer: Global Benefits Group Commercial |
$236.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$250.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$232.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$275.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$275.79
|
| Rate for Payer: Multiplan Commercial |
$315.19
|
| Rate for Payer: Networks By Design Commercial |
$256.09
|
| Rate for Payer: Prime Health Services Commercial |
$334.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.00
|
| Rate for Payer: United Healthcare All Other HMO |
$197.00
|
| Rate for Payer: United Healthcare HMO Rider |
$197.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.89
|
| Rate for Payer: Vantage Medical Group Senior |
$334.89
|
|
|
HC HELMET SOFT SHELL XXLG
|
Facility
|
IP
|
$393.99
|
|
| Hospital Charge Code |
901692013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$334.89 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.89
|
| Rate for Payer: Global Benefits Group Commercial |
$236.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$250.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$232.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.56
|
| Rate for Payer: Multiplan Commercial |
$315.19
|
| Rate for Payer: Networks By Design Commercial |
$256.09
|
| Rate for Payer: Prime Health Services Commercial |
$334.89
|
|
|
HC HEMATOCRIT HCT POC
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.92
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
