|
HC COLLAR MIAMI J SM
|
Facility
|
OP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$78.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.89
|
| Rate for Payer: Blue Shield of California Commercial |
$148.59
|
| Rate for Payer: Blue Shield of California EPN |
$96.88
|
| Rate for Payer: Cash Price |
$105.72
|
| Rate for Payer: Cash Price |
$105.72
|
| Rate for Payer: Central Health Plan Commercial |
$153.78
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Senior |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.64
|
| Rate for Payer: InnovAge PACE Commercial |
$96.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.55
|
| Rate for Payer: Multiplan Commercial |
$144.16
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: Riverside University Health System MISP |
$76.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.14
|
| Rate for Payer: United Healthcare All Other HMO |
$70.22
|
| Rate for Payer: United Healthcare HMO Rider |
$68.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.39
|
| Rate for Payer: Vantage Medical Group Senior |
$163.39
|
|
|
HC COLLAR MIAMI J STOUT
|
Facility
|
OP
|
$212.73
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.67 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$87.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.94
|
| Rate for Payer: Blue Shield of California Commercial |
$164.44
|
| Rate for Payer: Blue Shield of California EPN |
$107.22
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: Cigna of CA HMO |
$148.91
|
| Rate for Payer: Cigna of CA PPO |
$148.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.64
|
| Rate for Payer: InnovAge PACE Commercial |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.91
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$106.36
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
| Rate for Payer: Riverside University Health System MISP |
$85.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.84
|
| Rate for Payer: United Healthcare All Other HMO |
$77.71
|
| Rate for Payer: United Healthcare HMO Rider |
$76.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.82
|
| Rate for Payer: Vantage Medical Group Senior |
$180.82
|
|
|
HC COLLAR MIAMI J STOUT
|
Facility
|
IP
|
$212.73
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$191.46 |
| Rate for Payer: Adventist Health Commercial |
$42.55
|
| Rate for Payer: Blue Shield of California Commercial |
$164.44
|
| Rate for Payer: Blue Shield of California EPN |
$107.22
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: Cigna of CA HMO |
$148.91
|
| Rate for Payer: Cigna of CA PPO |
$148.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.55
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$138.27
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.84
|
| Rate for Payer: United Healthcare All Other HMO |
$77.71
|
| Rate for Payer: United Healthcare HMO Rider |
$76.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.67
|
|
|
HC COLLAR MIAMI J SUPER SHORT
|
Facility
|
IP
|
$212.73
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$191.46 |
| Rate for Payer: Adventist Health Commercial |
$42.55
|
| Rate for Payer: Blue Shield of California Commercial |
$164.44
|
| Rate for Payer: Blue Shield of California EPN |
$107.22
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: Cigna of CA HMO |
$148.91
|
| Rate for Payer: Cigna of CA PPO |
$148.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.55
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$138.27
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.84
|
| Rate for Payer: United Healthcare All Other HMO |
$77.71
|
| Rate for Payer: United Healthcare HMO Rider |
$76.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.67
|
|
|
HC COLLAR MIAMI J SUPER SHORT
|
Facility
|
OP
|
$212.73
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.67 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$87.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.94
|
| Rate for Payer: Blue Shield of California Commercial |
$164.44
|
| Rate for Payer: Blue Shield of California EPN |
$107.22
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: Cigna of CA HMO |
$148.91
|
| Rate for Payer: Cigna of CA PPO |
$148.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.64
|
| Rate for Payer: InnovAge PACE Commercial |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.91
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$106.36
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
| Rate for Payer: Riverside University Health System MISP |
$85.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.84
|
| Rate for Payer: United Healthcare All Other HMO |
$77.71
|
| Rate for Payer: United Healthcare HMO Rider |
$76.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.82
|
| Rate for Payer: Vantage Medical Group Senior |
$180.82
|
|
|
HC COLLAR MIAMI J UNIVERSAL
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698554
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Blue Shield of California Commercial |
$205.19
|
| Rate for Payer: Blue Shield of California EPN |
$133.78
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.09
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.62
|
| Rate for Payer: United Healthcare All Other HMO |
$96.97
|
| Rate for Payer: United Healthcare HMO Rider |
$94.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.93
|
|
|
HC COLLAR MIAMI J UNIVERSAL
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698554
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.93 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Adventist Health Commercial |
$108.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.89
|
| Rate for Payer: Blue Shield of California Commercial |
$205.19
|
| Rate for Payer: Blue Shield of California EPN |
$133.78
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.64
|
| Rate for Payer: InnovAge PACE Commercial |
$132.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.81
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$132.72
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: Riverside University Health System MISP |
$106.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.62
|
| Rate for Payer: United Healthcare All Other HMO |
$96.97
|
| Rate for Payer: United Healthcare HMO Rider |
$94.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.62
|
| Rate for Payer: Vantage Medical Group Senior |
$225.62
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
915350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$164.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Central Health Plan Commercial |
$260.80
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.35
|
| Rate for Payer: United Healthcare All Other HMO |
$119.09
|
| Rate for Payer: United Healthcare HMO Rider |
$116.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.77
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
905350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$164.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Central Health Plan Commercial |
$260.80
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.35
|
| Rate for Payer: United Healthcare All Other HMO |
$119.09
|
| Rate for Payer: United Healthcare HMO Rider |
$116.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.77
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
905350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.77 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Adventist Health Commercial |
$133.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$244.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.46
|
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$164.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Central Health Plan Commercial |
$260.80
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$117.41
|
| Rate for Payer: InnovAge PACE Commercial |
$163.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: Networks By Design Commercial |
$163.00
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Riverside University Health System MISP |
$130.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.35
|
| Rate for Payer: United Healthcare All Other HMO |
$119.09
|
| Rate for Payer: United Healthcare HMO Rider |
$116.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.10
|
| Rate for Payer: Vantage Medical Group Senior |
$277.10
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
915350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.77 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Adventist Health Commercial |
$133.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$244.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.46
|
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$164.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Central Health Plan Commercial |
$260.80
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$117.41
|
| Rate for Payer: InnovAge PACE Commercial |
$163.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: Networks By Design Commercial |
$163.00
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Riverside University Health System MISP |
$130.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.35
|
| Rate for Payer: United Healthcare All Other HMO |
$119.09
|
| Rate for Payer: United Healthcare HMO Rider |
$116.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.10
|
| Rate for Payer: Vantage Medical Group Senior |
$277.10
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
905350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$446.74 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Adventist Health Commercial |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,361.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,065.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,402.99
|
| Rate for Payer: Blue Shield of California EPN |
$914.76
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,452.00
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,542.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Senior |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,633.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.74
|
| Rate for Payer: InnovAge PACE Commercial |
$907.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,123.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,270.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,270.50
|
| Rate for Payer: Multiplan Commercial |
$1,361.25
|
| Rate for Payer: Networks By Design Commercial |
$907.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: Riverside University Health System MISP |
$726.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,089.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,089.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$681.17
|
| Rate for Payer: United Healthcare All Other HMO |
$663.02
|
| Rate for Payer: United Healthcare HMO Rider |
$648.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.75
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
IP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
905350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Adventist Health Commercial |
$363.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,402.99
|
| Rate for Payer: Blue Shield of California EPN |
$914.76
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,452.00
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Senior |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,633.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,123.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$1,361.25
|
| Rate for Payer: Networks By Design Commercial |
$1,179.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$681.17
|
| Rate for Payer: United Healthcare All Other HMO |
$663.02
|
| Rate for Payer: United Healthcare HMO Rider |
$648.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.41
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
915350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$446.74 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Adventist Health Commercial |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,361.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,065.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,402.99
|
| Rate for Payer: Blue Shield of California EPN |
$914.76
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,452.00
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,542.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Senior |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,633.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.74
|
| Rate for Payer: InnovAge PACE Commercial |
$907.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,123.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,270.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,270.50
|
| Rate for Payer: Multiplan Commercial |
$1,361.25
|
| Rate for Payer: Networks By Design Commercial |
$907.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: Riverside University Health System MISP |
$726.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,089.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,089.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$681.17
|
| Rate for Payer: United Healthcare All Other HMO |
$663.02
|
| Rate for Payer: United Healthcare HMO Rider |
$648.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.75
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
IP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
915350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Adventist Health Commercial |
$363.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,402.99
|
| Rate for Payer: Blue Shield of California EPN |
$914.76
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,452.00
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Senior |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,633.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,123.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$1,361.25
|
| Rate for Payer: Networks By Design Commercial |
$1,179.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$681.17
|
| Rate for Payer: United Healthcare All Other HMO |
$663.02
|
| Rate for Payer: United Healthcare HMO Rider |
$648.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.41
|
|
|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
915350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Adventist Health Commercial |
$261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.76
|
| Rate for Payer: Blue Shield of California EPN |
$657.72
|
| Rate for Payer: Cash Price |
$717.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,044.00
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Senior |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,174.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$807.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$978.75
|
| Rate for Payer: Networks By Design Commercial |
$848.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.77
|
| Rate for Payer: United Healthcare All Other HMO |
$476.72
|
| Rate for Payer: United Healthcare HMO Rider |
$466.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.39
|
|
|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
905350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$427.39 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Adventist Health Commercial |
$535.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$717.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$978.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$766.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.76
|
| Rate for Payer: Blue Shield of California EPN |
$657.72
|
| Rate for Payer: Cash Price |
$717.75
|
| Rate for Payer: Cash Price |
$717.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,044.00
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,109.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Senior |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,174.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$601.21
|
| Rate for Payer: InnovAge PACE Commercial |
$652.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$807.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$913.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$913.50
|
| Rate for Payer: Multiplan Commercial |
$978.75
|
| Rate for Payer: Networks By Design Commercial |
$652.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: Riverside University Health System MISP |
$522.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.77
|
| Rate for Payer: United Healthcare All Other HMO |
$476.72
|
| Rate for Payer: United Healthcare HMO Rider |
$466.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,109.25
|
|
|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
915350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$427.39 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Adventist Health Commercial |
$535.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$717.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$978.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$766.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.76
|
| Rate for Payer: Blue Shield of California EPN |
$657.72
|
| Rate for Payer: Cash Price |
$717.75
|
| Rate for Payer: Cash Price |
$717.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,044.00
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,109.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Senior |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,174.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$601.21
|
| Rate for Payer: InnovAge PACE Commercial |
$652.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$807.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$913.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$913.50
|
| Rate for Payer: Multiplan Commercial |
$978.75
|
| Rate for Payer: Networks By Design Commercial |
$652.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: Riverside University Health System MISP |
$522.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.77
|
| Rate for Payer: United Healthcare All Other HMO |
$476.72
|
| Rate for Payer: United Healthcare HMO Rider |
$466.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,109.25
|
|
|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
905350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Adventist Health Commercial |
$261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.76
|
| Rate for Payer: Blue Shield of California EPN |
$657.72
|
| Rate for Payer: Cash Price |
$717.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,044.00
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Senior |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,174.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$807.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$978.75
|
| Rate for Payer: Networks By Design Commercial |
$848.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.77
|
| Rate for Payer: United Healthcare All Other HMO |
$476.72
|
| Rate for Payer: United Healthcare HMO Rider |
$466.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.39
|
|
|
HC COLLAR PHILADELPHIA 3 1/4 MED
|
Facility
|
IP
|
$99.86
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$89.87 |
| Rate for Payer: Adventist Health Commercial |
$19.97
|
| Rate for Payer: Blue Shield of California Commercial |
$77.19
|
| Rate for Payer: Blue Shield of California EPN |
$50.33
|
| Rate for Payer: Cash Price |
$54.92
|
| Rate for Payer: Central Health Plan Commercial |
$79.89
|
| Rate for Payer: Cigna of CA HMO |
$69.90
|
| Rate for Payer: Cigna of CA PPO |
$69.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.94
|
| Rate for Payer: EPIC Health Plan Senior |
$39.94
|
| Rate for Payer: Galaxy Health WC |
$84.88
|
| Rate for Payer: Global Benefits Group Commercial |
$59.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.97
|
| Rate for Payer: Multiplan Commercial |
$74.89
|
| Rate for Payer: Networks By Design Commercial |
$64.91
|
| Rate for Payer: Prime Health Services Commercial |
$84.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.48
|
| Rate for Payer: United Healthcare All Other HMO |
$36.48
|
| Rate for Payer: United Healthcare HMO Rider |
$35.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.70
|
|
|
HC COLLAR PHILADELPHIA 3 1/4 MED
|
Facility
|
OP
|
$99.86
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$172.54 |
| Rate for Payer: Adventist Health Commercial |
$40.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.65
|
| Rate for Payer: Blue Shield of California Commercial |
$77.19
|
| Rate for Payer: Blue Shield of California EPN |
$50.33
|
| Rate for Payer: Cash Price |
$54.92
|
| Rate for Payer: Cash Price |
$54.92
|
| Rate for Payer: Central Health Plan Commercial |
$79.89
|
| Rate for Payer: Cigna of CA HMO |
$69.90
|
| Rate for Payer: Cigna of CA PPO |
$69.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.94
|
| Rate for Payer: EPIC Health Plan Senior |
$39.94
|
| Rate for Payer: Galaxy Health WC |
$84.88
|
| Rate for Payer: Global Benefits Group Commercial |
$59.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$156.19
|
| Rate for Payer: InnovAge PACE Commercial |
$49.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.90
|
| Rate for Payer: Multiplan Commercial |
$74.89
|
| Rate for Payer: Networks By Design Commercial |
$49.93
|
| Rate for Payer: Prime Health Services Commercial |
$84.88
|
| Rate for Payer: Riverside University Health System MISP |
$39.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.48
|
| Rate for Payer: United Healthcare All Other HMO |
$36.48
|
| Rate for Payer: United Healthcare HMO Rider |
$35.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.88
|
| Rate for Payer: Vantage Medical Group Senior |
$84.88
|
|
|
HC COLLAR PHILADELPHIA 4 1/4 MED
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Adventist Health Commercial |
$19.99
|
| Rate for Payer: Blue Shield of California Commercial |
$77.25
|
| Rate for Payer: Blue Shield of California EPN |
$50.37
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.99
|
| Rate for Payer: Multiplan Commercial |
$74.95
|
| Rate for Payer: Networks By Design Commercial |
$64.96
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
|
|
HC COLLAR PHILADELPHIA 4 1/4 MED
|
Facility
|
OP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$172.54 |
| Rate for Payer: Adventist Health Commercial |
$40.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.69
|
| Rate for Payer: Blue Shield of California Commercial |
$77.25
|
| Rate for Payer: Blue Shield of California EPN |
$50.37
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$156.19
|
| Rate for Payer: InnovAge PACE Commercial |
$49.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.96
|
| Rate for Payer: Multiplan Commercial |
$74.95
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: Riverside University Health System MISP |
$39.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.95
|
| Rate for Payer: Vantage Medical Group Senior |
$84.95
|
|
|
HC COLLAR PHILADELPHIA 5 1/4 MED
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Adventist Health Commercial |
$19.99
|
| Rate for Payer: Blue Shield of California Commercial |
$77.25
|
| Rate for Payer: Blue Shield of California EPN |
$50.37
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.99
|
| Rate for Payer: Multiplan Commercial |
$74.95
|
| Rate for Payer: Networks By Design Commercial |
$64.96
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
|
|
HC COLLAR PHILADELPHIA 5 1/4 MED
|
Facility
|
OP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$172.54 |
| Rate for Payer: Adventist Health Commercial |
$40.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.69
|
| Rate for Payer: Blue Shield of California Commercial |
$77.25
|
| Rate for Payer: Blue Shield of California EPN |
$50.37
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$156.19
|
| Rate for Payer: InnovAge PACE Commercial |
$49.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.96
|
| Rate for Payer: Multiplan Commercial |
$74.95
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: Riverside University Health System MISP |
$39.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.95
|
| Rate for Payer: Vantage Medical Group Senior |
$84.95
|
|
