|
HC COIL, TARGET HELICAL
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL, TARGET STANDARD
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,200.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,600.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,540.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,360.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
|
|
HC COIL, TARGET STANDARD
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,429.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,000.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,936.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,326.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,536.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,200.00
|
| Rate for Payer: Cigna of CA HMO |
$2,560.00
|
| Rate for Payer: Cigna of CA PPO |
$2,960.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,400.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,600.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,540.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,452.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,360.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,800.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,000.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,400.00
|
|
|
HC COIL ULTIPAQ
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL ULTIPAQ
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COLD AGGLUTININS SCREEN
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC COLD AGGLUTININS SCREEN
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$58.59
|
| Rate for Payer: Blue Shield of California EPN |
$36.92
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.32
|
| Rate for Payer: EPIC Health Plan Senior |
$8.88
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Prime Health Services Medicare |
$8.55
|
| Rate for Payer: Riverside University Health System MISP |
$8.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
|
|
HC COLD AGGLUTININ TITER
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.57
|
| Rate for Payer: Blue Shield of California Commercial |
$144.27
|
| Rate for Payer: Blue Shield of California EPN |
$90.91
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Central Health Plan Commercial |
$183.20
|
| Rate for Payer: Cigna of CA HMO |
$146.56
|
| Rate for Payer: Cigna of CA PPO |
$169.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.30
|
| Rate for Payer: EPIC Health Plan Senior |
$8.87
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.06
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
| Rate for Payer: Prime Health Services Medicare |
$8.54
|
| Rate for Payer: Riverside University Health System MISP |
$8.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.06
|
|
|
HC COLD AGGLUTININ TITER
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Central Health Plan Commercial |
$183.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: EPIC Health Plan Senior |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.80
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
|
|
HC COLLAR CERVICAL 4IN
|
Facility
|
OP
|
$18.78
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901698894
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.92
|
| Rate for Payer: Blue Shield of California Commercial |
$15.06
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Central Health Plan Commercial |
$15.02
|
| Rate for Payer: Cigna of CA HMO |
$13.15
|
| Rate for Payer: Cigna of CA PPO |
$13.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Senior |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$15.96
|
| Rate for Payer: Global Benefits Group Commercial |
$11.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$14.09
|
| Rate for Payer: Networks By Design Commercial |
$9.39
|
| Rate for Payer: Prime Health Services Commercial |
$15.96
|
| Rate for Payer: Riverside University Health System MISP |
$7.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.86
|
| Rate for Payer: United Healthcare HMO Rider |
$6.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.96
|
| Rate for Payer: Vantage Medical Group Senior |
$15.96
|
|
|
HC COLLAR CERVICAL 4IN
|
Facility
|
IP
|
$18.78
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901698894
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Adventist Health Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California Commercial |
$15.06
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Central Health Plan Commercial |
$15.02
|
| Rate for Payer: Cigna of CA HMO |
$13.15
|
| Rate for Payer: Cigna of CA PPO |
$13.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Senior |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$15.96
|
| Rate for Payer: Global Benefits Group Commercial |
$11.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Multiplan Commercial |
$14.09
|
| Rate for Payer: Networks By Design Commercial |
$12.21
|
| Rate for Payer: Prime Health Services Commercial |
$15.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.86
|
| Rate for Payer: United Healthcare HMO Rider |
$6.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
|
|
HC COLLAR CERVICAL LG 4.0 X 20
|
Facility
|
IP
|
$43.13
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$38.82 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Blue Shield of California Commercial |
$34.59
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$30.19
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.63
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$28.03
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$15.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.13
|
|
|
HC COLLAR CERVICAL LG 4.0 X 20
|
Facility
|
OP
|
$43.13
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.09
|
| Rate for Payer: Blue Shield of California Commercial |
$34.59
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$30.19
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.19
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$21.57
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
| Rate for Payer: Riverside University Health System MISP |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$15.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.66
|
| Rate for Payer: Vantage Medical Group Senior |
$36.66
|
|
|
HC COLLAR CERVICAL MED 4.0 X 18
|
Facility
|
IP
|
$43.13
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$38.82 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Blue Shield of California Commercial |
$34.59
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$30.19
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.63
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$28.03
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$15.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.13
|
|
|
HC COLLAR CERVICAL MED 4.0 X 18
|
Facility
|
OP
|
$43.13
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.09
|
| Rate for Payer: Blue Shield of California Commercial |
$34.59
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$30.19
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.19
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$21.57
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
| Rate for Payer: Riverside University Health System MISP |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$15.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.66
|
| Rate for Payer: Vantage Medical Group Senior |
$36.66
|
|
|
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 |
$1,237.50 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,102.75
|
| Rate for Payer: Blue Shield of California EPN |
$693.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,100.00
|
| 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: Health Management Network EPO/PPO |
$1,237.50
|
| 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 |
$275.00
|
| Rate for Payer: Multiplan Commercial |
$1,031.25
|
| 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
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT L0170
|
| Hospital Charge Code |
905350170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,102.75
|
| Rate for Payer: Blue Shield of California EPN |
$693.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,100.00
|
| 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: Health Management Network EPO/PPO |
$1,237.50
|
| 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 |
$275.00
|
| Rate for Payer: Multiplan Commercial |
$1,031.25
|
| 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 |
905350170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$450.31 |
| Max. Negotiated Rate |
$1,237.50 |
| 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 |
$799.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,102.75
|
| Rate for Payer: Blue Shield of California EPN |
$693.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,100.00
|
| 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: Health Management Network EPO/PPO |
$1,237.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$615.30
|
| 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 |
$563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$962.50
|
| Rate for Payer: Multiplan Commercial |
$1,031.25
|
| Rate for Payer: Networks By Design Commercial |
$687.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: Riverside University Health System MISP |
$550.00
|
| 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
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT L0170
|
| Hospital Charge Code |
915350170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$450.31 |
| Max. Negotiated Rate |
$1,237.50 |
| 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 |
$799.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,102.75
|
| Rate for Payer: Blue Shield of California EPN |
$693.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,100.00
|
| 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: Health Management Network EPO/PPO |
$1,237.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$615.30
|
| 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 |
$563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$962.50
|
| Rate for Payer: Multiplan Commercial |
$1,031.25
|
| Rate for Payer: Networks By Design Commercial |
$687.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: Riverside University Health System MISP |
$550.00
|
| 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 SM 3.5 X 16
|
Facility
|
OP
|
$43.13
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606821
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.09
|
| Rate for Payer: Blue Shield of California Commercial |
$34.59
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$30.19
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.19
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$21.57
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
| Rate for Payer: Riverside University Health System MISP |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$15.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.66
|
| Rate for Payer: Vantage Medical Group Senior |
$36.66
|
|
|
HC COLLAR CERVICAL SM 3.5 X 16
|
Facility
|
IP
|
$43.13
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606821
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$38.82 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Blue Shield of California Commercial |
$34.59
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$30.19
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.63
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$28.03
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$15.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.13
|
|
|
HC COLLAR CERVICAL SM XFIRM
|
Facility
|
OP
|
$79.87
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901698958
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$71.88 |
| 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 |
$46.46
|
| Rate for Payer: Blue Shield of California Commercial |
$64.06
|
| Rate for Payer: Blue Shield of California EPN |
$40.25
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Central Health Plan Commercial |
$63.90
|
| 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: Health Management Network EPO/PPO |
$71.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.64
|
| 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 |
$32.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.91
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Networks By Design Commercial |
$39.94
|
| Rate for Payer: Prime Health Services Commercial |
$67.89
|
| Rate for Payer: Riverside University Health System MISP |
$31.95
|
| 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 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 |
$71.88 |
| Rate for Payer: Adventist Health Commercial |
$15.97
|
| Rate for Payer: Blue Shield of California Commercial |
$64.06
|
| Rate for Payer: Blue Shield of California EPN |
$40.25
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Central Health Plan Commercial |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$55.91
|
| Rate for Payer: Cigna of CA PPO |
$55.91
|
| 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: Health Management Network EPO/PPO |
$71.88
|
| 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 |
$15.97
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| 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 X-LG 4.0 X 22
|
Facility
|
IP
|
$43.13
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$38.82 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Blue Shield of California Commercial |
$34.59
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$30.19
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.63
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$28.03
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$15.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.13
|
|
|
HC COLLAR CERVICAL X-LG 4.0 X 22
|
Facility
|
OP
|
$43.13
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.09
|
| Rate for Payer: Blue Shield of California Commercial |
$34.59
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$30.19
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.19
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$21.57
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
| Rate for Payer: Riverside University Health System MISP |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$15.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.66
|
| Rate for Payer: Vantage Medical Group Senior |
$36.66
|
|
