|
HC COVID 19 IGM IGG
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: EPIC Health Plan Senior |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC COVID19 RNA STAT
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
|
|
HC COVID19 RNA STAT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$262.47 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.27
|
| Rate for Payer: Blue Shield of California Commercial |
$160.25
|
| Rate for Payer: Blue Shield of California EPN |
$104.81
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$168.96
|
| Rate for Payer: Cigna of CA PPO |
$195.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$262.47 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.27
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
OP
|
$5,495.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$4,945.50 |
| Rate for Payer: Adventist Health Commercial |
$1,099.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,337.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$3,022.25
|
| Rate for Payer: Cash Price |
$3,022.25
|
| Rate for Payer: Cash Price |
$3,022.25
|
| Rate for Payer: Cash Price |
$3,022.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,516.80
|
| Rate for Payer: Cigna of CA PPO |
$4,066.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$4,670.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,297.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,945.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,665.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$4,121.25
|
| Rate for Payer: Networks By Design Commercial |
$3,571.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Prime Health Services Commercial |
$4,670.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,297.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,297.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
IP
|
$5,495.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,099.00 |
| Max. Negotiated Rate |
$4,945.50 |
| Rate for Payer: Adventist Health Commercial |
$1,099.00
|
| Rate for Payer: Cash Price |
$3,022.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,396.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,198.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,198.00
|
| Rate for Payer: Galaxy Health WC |
$4,670.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,297.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,945.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,665.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,093.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,401.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.00
|
| Rate for Payer: Multiplan Commercial |
$4,121.25
|
| Rate for Payer: Networks By Design Commercial |
$3,571.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,670.75
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: InnovAge PACE Commercial |
$38.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Riverside University Health System MISP |
$30.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: InnovAge PACE Commercial |
$115.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
OP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$289.03 |
| Max. Negotiated Rate |
$2,493.90 |
| Rate for Payer: Adventist Health Commercial |
$554.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,355.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,524.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,078.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,341.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,627.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,693.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,105.63
|
| Rate for Payer: Cash Price |
$1,524.05
|
| Rate for Payer: Cash Price |
$1,524.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.80
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,355.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,355.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,355.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.40
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,493.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.03
|
| Rate for Payer: InnovAge PACE Commercial |
$1,385.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,715.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,939.70
|
| Rate for Payer: Multiplan Commercial |
$2,078.25
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,108.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,662.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,662.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.25
|
| Rate for Payer: United Healthcare HMO Rider |
$990.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,355.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,355.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,355.35
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
IP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$554.20 |
| Max. Negotiated Rate |
$2,493.90 |
| Rate for Payer: Adventist Health Commercial |
$554.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,141.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,396.58
|
| Rate for Payer: Cash Price |
$1,524.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.80
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.40
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,493.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,055.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,715.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.20
|
| Rate for Payer: Multiplan Commercial |
$2,078.25
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.25
|
| Rate for Payer: United Healthcare HMO Rider |
$990.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.50
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
915350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,700.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,361.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,430.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
915350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$720.50 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Adventist Health Commercial |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,292.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,700.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,361.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Riverside University Health System MISP |
$880.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.00
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$720.50 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Adventist Health Commercial |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,292.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,700.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,361.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Riverside University Health System MISP |
$880.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.00
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,700.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,361.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,430.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
OP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
915350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.27 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Adventist Health Commercial |
$325.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$466.74
|
| Rate for Payer: Blue Shield of California Commercial |
$614.33
|
| Rate for Payer: Blue Shield of California EPN |
$400.54
|
| Rate for Payer: Cash Price |
$437.10
|
| Rate for Payer: Cash Price |
$437.10
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$675.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.79
|
| Rate for Payer: InnovAge PACE Commercial |
$397.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$556.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$556.31
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: Riverside University Health System MISP |
$317.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.52
|
| Rate for Payer: Vantage Medical Group Senior |
$675.52
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
OP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.27 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Adventist Health Commercial |
$325.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$466.74
|
| Rate for Payer: Blue Shield of California Commercial |
$614.33
|
| Rate for Payer: Blue Shield of California EPN |
$400.54
|
| Rate for Payer: Cash Price |
$437.10
|
| Rate for Payer: Cash Price |
$437.10
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$675.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.79
|
| Rate for Payer: InnovAge PACE Commercial |
$397.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$556.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$556.31
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: Riverside University Health System MISP |
$317.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.52
|
| Rate for Payer: Vantage Medical Group Senior |
$675.52
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
IP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
915350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Adventist Health Commercial |
$158.95
|
| Rate for Payer: Blue Shield of California Commercial |
$614.33
|
| Rate for Payer: Blue Shield of California EPN |
$400.54
|
| Rate for Payer: Cash Price |
$437.10
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.95
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$516.57
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
IP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Adventist Health Commercial |
$158.95
|
| Rate for Payer: Blue Shield of California Commercial |
$614.33
|
| Rate for Payer: Blue Shield of California EPN |
$400.54
|
| Rate for Payer: Cash Price |
$437.10
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.95
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$516.57
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
OP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,697.76 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Adventist Health Commercial |
$2,125.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,851.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,888.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,044.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4,007.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,612.74
|
| Rate for Payer: Cash Price |
$2,851.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,406.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: InnovAge PACE Commercial |
$2,592.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,125.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,628.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,628.80
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,073.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,406.40
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
IP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Adventist Health Commercial |
$1,036.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,007.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,612.74
|
| Rate for Payer: Cash Price |
$2,851.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,975.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.80
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$3,369.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
OP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
915368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,697.76 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Adventist Health Commercial |
$2,125.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,851.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,888.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,044.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4,007.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,612.74
|
| Rate for Payer: Cash Price |
$2,851.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,406.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: InnovAge PACE Commercial |
$2,592.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,125.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,628.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,628.80
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,073.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,406.40
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
IP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
915368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Adventist Health Commercial |
$1,036.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,007.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,612.74
|
| Rate for Payer: Cash Price |
$2,851.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,975.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.80
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$3,369.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
|
