|
HC COIL PRESIDIO
|
Facility
|
OP
|
$6,375.00
|
|
| Hospital Charge Code |
909020099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,871.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,506.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,086.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,766.35
|
| Rate for Payer: Blue Distinction Transplant |
$3,825.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,009.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,117.38
|
| Rate for Payer: Cash Price |
$2,868.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| Rate for Payer: Cigna of CA HMO |
$4,080.00
|
| Rate for Payer: Cigna of CA PPO |
$4,717.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Dignity Health Media |
$5,418.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,418.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,550.00
|
| Rate for Payer: Galaxy Health WC |
$5,418.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,737.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,781.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,231.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| Rate for Payer: Networks By Design Commercial |
$4,143.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,550.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,187.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,187.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,187.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,187.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,418.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,418.75
|
|
|
HC COIL, TARGET 360 SOFT
|
Facility
|
IP
|
$4,250.00
|
|
| Hospital Charge Code |
909020138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.00 |
| Max. Negotiated Rate |
$3,825.00 |
| Rate for Payer: Cash Price |
$1,912.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,700.00
|
| Rate for Payer: Galaxy Health WC |
$3,612.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,825.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,834.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,619.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.00
|
| Rate for Payer: Multiplan Commercial |
$3,187.50
|
| Rate for Payer: Networks By Design Commercial |
$2,762.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,612.50
|
|
|
HC COIL, TARGET 360 SOFT
|
Facility
|
OP
|
$4,250.00
|
|
| Hospital Charge Code |
909020138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.00 |
| Max. Negotiated Rate |
$3,825.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,581.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,612.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,337.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,337.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,057.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,510.90
|
| Rate for Payer: Blue Distinction Transplant |
$2,550.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,673.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,078.25
|
| Rate for Payer: Cash Price |
$1,912.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,400.00
|
| Rate for Payer: Cigna of CA HMO |
$2,720.00
|
| Rate for Payer: Cigna of CA PPO |
$3,145.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,612.50
|
| Rate for Payer: Dignity Health Media |
$3,612.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,700.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,700.00
|
| Rate for Payer: Galaxy Health WC |
$3,612.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,825.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,187.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,487.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,834.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,619.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.00
|
| Rate for Payer: Multiplan Commercial |
$3,187.50
|
| Rate for Payer: Networks By Design Commercial |
$2,762.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,612.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,612.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,612.50
|
|
|
HC COIL TARGET 360 ULTRA
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL TARGET 360 ULTRA
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL, TARGET HELICAL
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL, TARGET HELICAL
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL, TARGET STANDARD
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,429.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,200.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,936.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,363.20
|
| Rate for Payer: Blue Distinction Transplant |
$2,400.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,516.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,200.00
|
| Rate for Payer: Cigna of CA HMO |
$2,560.00
|
| Rate for Payer: Cigna of CA PPO |
$2,960.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Dignity Health Media |
$3,400.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,600.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,000.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,000.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,000.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,400.00
|
|
|
HC COIL, TARGET STANDARD
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
|
|
HC COIL ULTIPAQ
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL ULTIPAQ
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COLD AGGLUTININS SCREEN
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$124.80
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
|
|
HC COLD AGGLUTININS SCREEN
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.96
|
| Rate for Payer: Blue Distinction Transplant |
$115.20
|
| Rate for Payer: Blue Shield of California Commercial |
$118.66
|
| Rate for Payer: Blue Shield of California EPN |
$93.31
|
| Rate for Payer: Caremore Medicare Advantage |
$8.07
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$122.88
|
| Rate for Payer: Cigna of CA PPO |
$142.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.10
|
| Rate for Payer: Dignity Health Media |
$8.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.07
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$144.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.07
|
| Rate for Payer: InnovAge PACE Commercial |
$12.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$124.80
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Prime Health Services Medicare |
$8.55
|
| Rate for Payer: Riverside University Health System MISP |
$8.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
|
|
HC COLD AGGLUTININ TITER
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.57
|
| Rate for Payer: Blue Distinction Transplant |
$160.80
|
| Rate for Payer: Blue Shield of California Commercial |
$165.62
|
| Rate for Payer: Blue Shield of California EPN |
$130.25
|
| Rate for Payer: Caremore Medicare Advantage |
$8.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.09
|
| Rate for Payer: Dignity Health Media |
$8.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.06
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$201.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.06
|
| Rate for Payer: InnovAge PACE Commercial |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Prime Health Services Medicare |
$8.54
|
| Rate for Payer: Riverside University Health System MISP |
$8.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.06
|
|
|
HC COLD AGGLUTININ TITER
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC COLLAR CERVICAL LG 4.0 X 20
|
Facility
|
OP
|
$41.16
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.32
|
| Rate for Payer: Blue Distinction Transplant |
$24.70
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California EPN |
$22.39
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Central Health Plan Commercial |
$32.93
|
| Rate for Payer: Cigna of CA HMO |
$28.81
|
| Rate for Payer: Cigna of CA PPO |
$28.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.99
|
| Rate for Payer: Dignity Health Media |
$34.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$30.87
|
| Rate for Payer: Networks By Design Commercial |
$20.58
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
| Rate for Payer: Riverside University Health System MISP |
$16.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.58
|
| Rate for Payer: United Healthcare All Other HMO |
$20.58
|
| Rate for Payer: United Healthcare HMO Rider |
$20.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.99
|
| Rate for Payer: Vantage Medical Group Senior |
$34.99
|
|
|
HC COLLAR CERVICAL LG 4.0 X 20
|
Facility
|
IP
|
$41.16
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$37.04 |
| Rate for Payer: Blue Shield of California EPN |
$21.98
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Central Health Plan Commercial |
$32.93
|
| Rate for Payer: Cigna of CA HMO |
$28.81
|
| Rate for Payer: Cigna of CA PPO |
$28.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.23
|
| Rate for Payer: Multiplan Commercial |
$30.87
|
| Rate for Payer: Networks By Design Commercial |
$20.58
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.54
|
| Rate for Payer: United Healthcare All Other HMO |
$15.18
|
| Rate for Payer: United Healthcare HMO Rider |
$14.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.58
|
|
|
HC COLLAR CERVICAL MED 4.0 X 18
|
Facility
|
OP
|
$41.16
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.32
|
| Rate for Payer: Blue Distinction Transplant |
$24.70
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California EPN |
$22.39
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Central Health Plan Commercial |
$32.93
|
| Rate for Payer: Cigna of CA HMO |
$28.81
|
| Rate for Payer: Cigna of CA PPO |
$28.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.99
|
| Rate for Payer: Dignity Health Media |
$34.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$30.87
|
| Rate for Payer: Networks By Design Commercial |
$20.58
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
| Rate for Payer: Riverside University Health System MISP |
$16.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.58
|
| Rate for Payer: United Healthcare All Other HMO |
$20.58
|
| Rate for Payer: United Healthcare HMO Rider |
$20.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.99
|
| Rate for Payer: Vantage Medical Group Senior |
$34.99
|
|
|
HC COLLAR CERVICAL MED 4.0 X 18
|
Facility
|
IP
|
$41.16
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$37.04 |
| Rate for Payer: Blue Shield of California EPN |
$21.98
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Central Health Plan Commercial |
$32.93
|
| Rate for Payer: Cigna of CA HMO |
$28.81
|
| Rate for Payer: Cigna of CA PPO |
$28.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.23
|
| Rate for Payer: Multiplan Commercial |
$30.87
|
| Rate for Payer: Networks By Design Commercial |
$20.58
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.54
|
| Rate for Payer: United Healthcare All Other HMO |
$15.18
|
| Rate for Payer: United Healthcare HMO Rider |
$14.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.58
|
|
|
HC COLLAR CERVICAL MOLDED TO PT
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT L0170
|
| Hospital Charge Code |
905350170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Blue Shield of California EPN |
$734.25
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,100.00
|
| Rate for Payer: Cigna of CA HMO |
$962.50
|
| Rate for Payer: Cigna of CA PPO |
$962.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$550.00
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,237.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.00
|
| Rate for Payer: Multiplan Commercial |
$1,031.25
|
| Rate for Payer: Networks By Design Commercial |
$687.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$519.20
|
| Rate for Payer: United Healthcare All Other HMO |
$507.10
|
| Rate for Payer: United Healthcare HMO Rider |
$496.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$453.75
|
|
|
HC COLLAR CERVICAL MOLDED TO PT
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT L0170
|
| Hospital Charge Code |
905350170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$481.25 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$756.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$665.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$812.35
|
| Rate for Payer: Blue Distinction Transplant |
$825.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,031.25
|
| Rate for Payer: Blue Shield of California EPN |
$748.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,100.00
|
| Rate for Payer: Cigna of CA HMO |
$962.50
|
| Rate for Payer: Cigna of CA PPO |
$962.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.75
|
| Rate for Payer: Dignity Health Media |
$1,168.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,168.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$550.00
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,237.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,031.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$481.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.75
|
| Rate for Payer: Multiplan Commercial |
$1,031.25
|
| Rate for Payer: Networks By Design Commercial |
$687.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: Riverside University Health System MISP |
$550.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$687.50
|
| Rate for Payer: United Healthcare All Other HMO |
$687.50
|
| Rate for Payer: United Healthcare HMO Rider |
$687.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$687.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,168.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,168.75
|
|
|
HC COLLAR CERVICAL SM 3.5 X 16
|
Facility
|
IP
|
$41.16
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606821
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$37.04 |
| Rate for Payer: Blue Shield of California EPN |
$21.98
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Central Health Plan Commercial |
$32.93
|
| Rate for Payer: Cigna of CA HMO |
$28.81
|
| Rate for Payer: Cigna of CA PPO |
$28.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.23
|
| Rate for Payer: Multiplan Commercial |
$30.87
|
| Rate for Payer: Networks By Design Commercial |
$20.58
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.54
|
| Rate for Payer: United Healthcare All Other HMO |
$15.18
|
| Rate for Payer: United Healthcare HMO Rider |
$14.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.58
|
|
|
HC COLLAR CERVICAL SM 3.5 X 16
|
Facility
|
OP
|
$41.16
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606821
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.32
|
| Rate for Payer: Blue Distinction Transplant |
$24.70
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California EPN |
$22.39
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Central Health Plan Commercial |
$32.93
|
| Rate for Payer: Cigna of CA HMO |
$28.81
|
| Rate for Payer: Cigna of CA PPO |
$28.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.99
|
| Rate for Payer: Dignity Health Media |
$34.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$30.87
|
| Rate for Payer: Networks By Design Commercial |
$20.58
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
| Rate for Payer: Riverside University Health System MISP |
$16.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.58
|
| Rate for Payer: United Healthcare All Other HMO |
$20.58
|
| Rate for Payer: United Healthcare HMO Rider |
$20.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.99
|
| Rate for Payer: Vantage Medical Group Senior |
$34.99
|
|
|
HC COLLAR CERVICAL X-LG 4.0 X 22
|
Facility
|
OP
|
$32.47
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.18
|
| Rate for Payer: Blue Distinction Transplant |
$19.48
|
| Rate for Payer: Blue Shield of California Commercial |
$24.35
|
| Rate for Payer: Blue Shield of California EPN |
$17.66
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Central Health Plan Commercial |
$25.98
|
| Rate for Payer: Cigna of CA HMO |
$22.73
|
| Rate for Payer: Cigna of CA PPO |
$22.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Media |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.99
|
| Rate for Payer: Galaxy Health WC |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$24.35
|
| Rate for Payer: Networks By Design Commercial |
$16.24
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
| Rate for Payer: Riverside University Health System MISP |
$12.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.24
|
| Rate for Payer: United Healthcare All Other HMO |
$16.24
|
| Rate for Payer: United Healthcare HMO Rider |
$16.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.60
|
| Rate for Payer: Vantage Medical Group Senior |
$27.60
|
|
|
HC COLLAR CERVICAL X-LG 4.0 X 22
|
Facility
|
IP
|
$32.47
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Blue Shield of California EPN |
$17.34
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Central Health Plan Commercial |
$25.98
|
| Rate for Payer: Cigna of CA HMO |
$22.73
|
| Rate for Payer: Cigna of CA PPO |
$22.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.99
|
| Rate for Payer: Galaxy Health WC |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Multiplan Commercial |
$24.35
|
| Rate for Payer: Networks By Design Commercial |
$16.24
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.26
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.72
|
|
