|
HC COIL TERUMO AZUR CX 018 8X28
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
HC COIL TERUMO AZUR CX 035 4X7
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
906812574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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 |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC COIL TERUMO AZUR CX 035 4X7
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
906812574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| 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 |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| 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: 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: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| 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 |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| 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 COIL TERUMO AZUR CX 035 5X11
|
Facility
|
IP
|
$2,730.00
|
|
| Hospital Charge Code |
906812608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,110.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,375.92
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,911.00
|
| Rate for Payer: Cigna of CA PPO |
$1,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Networks By Design Commercial |
$1,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,024.57
|
| Rate for Payer: United Healthcare All Other HMO |
$997.27
|
| Rate for Payer: United Healthcare HMO Rider |
$975.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.08
|
|
|
HC COIL TERUMO AZUR CX 035 5X11
|
Facility
|
OP
|
$2,730.00
|
|
| Hospital Charge Code |
906812608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,246.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,511.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,110.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,375.92
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,911.00
|
| Rate for Payer: Cigna of CA PPO |
$1,911.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,911.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Networks By Design Commercial |
$1,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,024.57
|
| Rate for Payer: United Healthcare All Other HMO |
$997.27
|
| Rate for Payer: United Healthcare HMO Rider |
$975.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC COIL TERUMO AZUR CX 035 6X9
|
Facility
|
IP
|
$2,730.00
|
|
| Hospital Charge Code |
906812609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,110.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,375.92
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,911.00
|
| Rate for Payer: Cigna of CA PPO |
$1,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Networks By Design Commercial |
$1,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,024.57
|
| Rate for Payer: United Healthcare All Other HMO |
$997.27
|
| Rate for Payer: United Healthcare HMO Rider |
$975.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.08
|
|
|
HC COIL TERUMO AZUR CX 035 6X9
|
Facility
|
OP
|
$2,730.00
|
|
| Hospital Charge Code |
906812609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,246.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,511.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,110.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,375.92
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,911.00
|
| Rate for Payer: Cigna of CA PPO |
$1,911.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,911.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Networks By Design Commercial |
$1,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,024.57
|
| Rate for Payer: United Healthcare All Other HMO |
$997.27
|
| Rate for Payer: United Healthcare HMO Rider |
$975.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
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 |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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 |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$56.48
|
| 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 |
$9.81
|
| Rate for Payer: Blue Shield of California Commercial |
$56.45
|
| Rate for Payer: Blue Shield of California EPN |
$36.92
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cash Price |
$51.15
|
| 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: EPIC Health Plan Commercial |
$10.89
|
| Rate for Payer: EPIC Health Plan Senior |
$8.07
|
| 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: InnovAge PACE Commercial |
$12.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.81
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$51.15
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| 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 Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.57
|
| 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 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 |
$139.07
|
| 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 |
$11.91
|
| Rate for Payer: Blue Shield of California Commercial |
$139.00
|
| Rate for Payer: Blue Shield of California EPN |
$90.91
|
| Rate for Payer: Cash Price |
$125.95
|
| Rate for Payer: Cash Price |
$125.95
|
| 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: EPIC Health Plan Commercial |
$10.88
|
| Rate for Payer: EPIC Health Plan Senior |
$8.06
|
| 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: InnovAge PACE Commercial |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
$125.95
|
| Rate for Payer: Central Health Plan Commercial |
$183.20
|
| 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 Permanente of CA Commercial/Self Funded |
$152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.75
|
| 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 |
$11.03
|
| Rate for Payer: Blue Shield of California Commercial |
$14.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.33
|
| 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: 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: InnovAge PACE Commercial |
$9.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.15
|
| Rate for Payer: Molina Healthcare of CA 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 |
$14.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Cash Price |
$10.33
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.62
|
| 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
|
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 |
$25.33
|
| Rate for Payer: Blue Shield of California Commercial |
$33.34
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cash Price |
$23.72
|
| 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: 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: InnovAge PACE Commercial |
$21.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.19
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$33.34
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$23.72
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.70
|
| 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 |
$25.33
|
| Rate for Payer: Blue Shield of California Commercial |
$33.34
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cash Price |
$23.72
|
| 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: 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: InnovAge PACE Commercial |
$21.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.19
|
| Rate for Payer: Molina Healthcare of CA 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 |
$33.34
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$23.72
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.70
|
| 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 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 |
$807.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.88
|
| Rate for Payer: Blue Shield of California EPN |
$693.00
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cash Price |
$756.25
|
| 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: 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: InnovAge PACE Commercial |
$687.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$851.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$962.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$962.50
|
| Rate for Payer: Multiplan Commercial |
$1,031.25
|
| 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 |
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 |
$807.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.88
|
| Rate for Payer: Blue Shield of California EPN |
$693.00
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cash Price |
$756.25
|
| 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: 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: InnovAge PACE Commercial |
$687.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$851.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$962.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$962.50
|
| Rate for Payer: Multiplan Commercial |
$1,031.25
|
| 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
|
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 |
$1,062.88
|
| Rate for Payer: Blue Shield of California EPN |
$693.00
|
| Rate for Payer: Cash Price |
$756.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$851.12
|
| 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 |
$1,062.88
|
| Rate for Payer: Blue Shield of California EPN |
$693.00
|
| Rate for Payer: Cash Price |
$756.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$851.12
|
| 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 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 |
$25.33
|
| Rate for Payer: Blue Shield of California Commercial |
$33.34
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cash Price |
$23.72
|
| 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: 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: InnovAge PACE Commercial |
$21.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.19
|
| Rate for Payer: Molina Healthcare of CA 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 |
$33.34
|
| Rate for Payer: Blue Shield of California EPN |
$21.74
|
| Rate for Payer: Cash Price |
$23.72
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.70
|
| 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
|
|
