|
HC COLLAR FLEXIBLE FOAM
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
905350120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.17
|
| Rate for Payer: Blue Distinction Transplant |
$40.80
|
| Rate for Payer: Blue Shield of California Commercial |
$51.00
|
| Rate for Payer: Blue Shield of California EPN |
$36.99
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$47.60
|
| Rate for Payer: Cigna of CA PPO |
$47.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.80
|
| Rate for Payer: Dignity Health Media |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$51.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.88
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Riverside University Health System MISP |
$27.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.00
|
| Rate for Payer: United Healthcare All Other HMO |
$34.00
|
| Rate for Payer: United Healthcare HMO Rider |
$34.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.80
|
| Rate for Payer: Vantage Medical Group Senior |
$57.80
|
|
|
HC COLLAR FLEXIBLE FOAM
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
905350120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Blue Shield of California EPN |
$36.31
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$47.60
|
| Rate for Payer: Cigna of CA PPO |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.68
|
| Rate for Payer: United Healthcare All Other HMO |
$25.08
|
| Rate for Payer: United Healthcare HMO Rider |
$24.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.44
|
|
|
HC COLLAR MIAMI J ACCESSORY
|
Facility
|
IP
|
$527.92
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.58 |
| Max. Negotiated Rate |
$475.13 |
| Rate for Payer: Blue Shield of California EPN |
$281.91
|
| Rate for Payer: Cash Price |
$237.56
|
| Rate for Payer: Central Health Plan Commercial |
$422.34
|
| Rate for Payer: Cigna of CA HMO |
$369.54
|
| Rate for Payer: Cigna of CA PPO |
$369.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$211.17
|
| Rate for Payer: Galaxy Health WC |
$448.73
|
| Rate for Payer: Global Benefits Group Commercial |
$316.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.58
|
| Rate for Payer: Multiplan Commercial |
$395.94
|
| Rate for Payer: Networks By Design Commercial |
$263.96
|
| Rate for Payer: Prime Health Services Commercial |
$448.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.34
|
| Rate for Payer: United Healthcare All Other HMO |
$194.70
|
| Rate for Payer: United Healthcare HMO Rider |
$190.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.21
|
|
|
HC COLLAR MIAMI J ACCESSORY
|
Facility
|
OP
|
$527.92
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$184.77 |
| Max. Negotiated Rate |
$475.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$448.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$255.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.90
|
| Rate for Payer: Blue Distinction Transplant |
$316.75
|
| Rate for Payer: Blue Shield of California Commercial |
$395.94
|
| Rate for Payer: Blue Shield of California EPN |
$287.19
|
| Rate for Payer: Cash Price |
$237.56
|
| Rate for Payer: Cash Price |
$237.56
|
| Rate for Payer: Central Health Plan Commercial |
$422.34
|
| Rate for Payer: Cigna of CA HMO |
$369.54
|
| Rate for Payer: Cigna of CA PPO |
$369.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$448.73
|
| Rate for Payer: Dignity Health Media |
$448.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$448.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$211.17
|
| Rate for Payer: Galaxy Health WC |
$448.73
|
| Rate for Payer: Global Benefits Group Commercial |
$316.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$395.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$184.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.45
|
| Rate for Payer: Multiplan Commercial |
$395.94
|
| Rate for Payer: Networks By Design Commercial |
$263.96
|
| Rate for Payer: Prime Health Services Commercial |
$448.73
|
| Rate for Payer: Riverside University Health System MISP |
$211.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.96
|
| Rate for Payer: United Healthcare All Other HMO |
$263.96
|
| Rate for Payer: United Healthcare HMO Rider |
$263.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$448.73
|
| Rate for Payer: Vantage Medical Group Senior |
$448.73
|
|
|
HC COLLAR MIAMI J LG
|
Facility
|
OP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.28 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.56
|
| Rate for Payer: Blue Distinction Transplant |
$115.33
|
| Rate for Payer: Blue Shield of California Commercial |
$144.16
|
| Rate for Payer: Blue Shield of California EPN |
$104.57
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Central Health Plan Commercial |
$153.78
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.39
|
| Rate for Payer: Dignity Health Media |
$163.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$144.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.81
|
| Rate for Payer: Multiplan Commercial |
$144.16
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: Riverside University Health System MISP |
$76.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.11
|
| Rate for Payer: United Healthcare All Other HMO |
$96.11
|
| Rate for Payer: United Healthcare HMO Rider |
$96.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.39
|
| Rate for Payer: Vantage Medical Group Senior |
$163.39
|
|
|
HC COLLAR MIAMI J LG
|
Facility
|
IP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Blue Shield of California EPN |
$102.65
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Central Health Plan Commercial |
$153.78
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.44
|
| Rate for Payer: Multiplan Commercial |
$144.16
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.58
|
| Rate for Payer: United Healthcare All Other HMO |
$70.89
|
| Rate for Payer: United Healthcare HMO Rider |
$69.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.43
|
|
|
HC COLLAR MIAMI J MED
|
Facility
|
IP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Blue Shield of California EPN |
$102.65
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Central Health Plan Commercial |
$153.78
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.44
|
| Rate for Payer: Multiplan Commercial |
$144.16
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.58
|
| Rate for Payer: United Healthcare All Other HMO |
$70.89
|
| Rate for Payer: United Healthcare HMO Rider |
$69.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.43
|
|
|
HC COLLAR MIAMI J MED
|
Facility
|
OP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.28 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.56
|
| Rate for Payer: Blue Distinction Transplant |
$115.33
|
| Rate for Payer: Blue Shield of California Commercial |
$144.16
|
| Rate for Payer: Blue Shield of California EPN |
$104.57
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Central Health Plan Commercial |
$153.78
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.39
|
| Rate for Payer: Dignity Health Media |
$163.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$144.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.81
|
| Rate for Payer: Multiplan Commercial |
$144.16
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: Riverside University Health System MISP |
$76.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.11
|
| Rate for Payer: United Healthcare All Other HMO |
$96.11
|
| Rate for Payer: United Healthcare HMO Rider |
$96.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.39
|
| Rate for Payer: Vantage Medical Group Senior |
$163.39
|
|
|
HC COLLAR MIAMI J OCCIAN BACK JR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698297
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC COLLAR MIAMI J OCCIAN BACK JR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698297
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
HC COLLAR MIAMI J PEDS P1
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605407
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Blue Shield of California EPN |
$182.23
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.86
|
| Rate for Payer: United Healthcare All Other HMO |
$125.85
|
| Rate for Payer: United Healthcare HMO Rider |
$123.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.61
|
|
|
HC COLLAR MIAMI J PEDS P1
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605407
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.44 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.61
|
| Rate for Payer: Blue Distinction Transplant |
$204.75
|
| Rate for Payer: Blue Shield of California Commercial |
$255.94
|
| Rate for Payer: Blue Shield of California EPN |
$185.64
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.06
|
| Rate for Payer: Dignity Health Media |
$290.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$255.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.91
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: Riverside University Health System MISP |
$136.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.62
|
| Rate for Payer: United Healthcare All Other HMO |
$170.62
|
| Rate for Payer: United Healthcare HMO Rider |
$170.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.06
|
| Rate for Payer: Vantage Medical Group Senior |
$290.06
|
|
|
HC COLLAR MIAMI J PEDS P2
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605408
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.44 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.61
|
| Rate for Payer: Blue Distinction Transplant |
$204.75
|
| Rate for Payer: Blue Shield of California Commercial |
$255.94
|
| Rate for Payer: Blue Shield of California EPN |
$185.64
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.06
|
| Rate for Payer: Dignity Health Media |
$290.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$255.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.91
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: Riverside University Health System MISP |
$136.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.62
|
| Rate for Payer: United Healthcare All Other HMO |
$170.62
|
| Rate for Payer: United Healthcare HMO Rider |
$170.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.06
|
| Rate for Payer: Vantage Medical Group Senior |
$290.06
|
|
|
HC COLLAR MIAMI J PEDS P2
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605408
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Blue Shield of California EPN |
$182.23
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.86
|
| Rate for Payer: United Healthcare All Other HMO |
$125.85
|
| Rate for Payer: United Healthcare HMO Rider |
$123.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.61
|
|
|
HC COLLAR MIAMI J PEDS P3
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605409
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.44 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.61
|
| Rate for Payer: Blue Distinction Transplant |
$204.75
|
| Rate for Payer: Blue Shield of California Commercial |
$255.94
|
| Rate for Payer: Blue Shield of California EPN |
$185.64
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.06
|
| Rate for Payer: Dignity Health Media |
$290.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$255.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.91
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: Riverside University Health System MISP |
$136.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.62
|
| Rate for Payer: United Healthcare All Other HMO |
$170.62
|
| Rate for Payer: United Healthcare HMO Rider |
$170.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.06
|
| Rate for Payer: Vantage Medical Group Senior |
$290.06
|
|
|
HC COLLAR MIAMI J PEDS P3
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605409
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Blue Shield of California EPN |
$182.23
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.86
|
| Rate for Payer: United Healthcare All Other HMO |
$125.85
|
| Rate for Payer: United Healthcare HMO Rider |
$123.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.61
|
|
|
HC COLLAR MIAMI J PEDS PO
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605406
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Blue Shield of California EPN |
$182.23
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.86
|
| Rate for Payer: United Healthcare All Other HMO |
$125.85
|
| Rate for Payer: United Healthcare HMO Rider |
$123.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.61
|
|
|
HC COLLAR MIAMI J PEDS PO
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605406
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.44 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.61
|
| Rate for Payer: Blue Distinction Transplant |
$204.75
|
| Rate for Payer: Blue Shield of California Commercial |
$255.94
|
| Rate for Payer: Blue Shield of California EPN |
$185.64
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.06
|
| Rate for Payer: Dignity Health Media |
$290.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$255.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.91
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: Riverside University Health System MISP |
$136.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.62
|
| Rate for Payer: United Healthcare All Other HMO |
$170.62
|
| Rate for Payer: United Healthcare HMO Rider |
$170.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.06
|
| Rate for Payer: Vantage Medical Group Senior |
$290.06
|
|
|
HC COLLAR MIAMI J REPLACEMENT PAD
|
Facility
|
IP
|
$160.44
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901698555
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Shield of California EPN |
$85.67
|
| Rate for Payer: Cash Price |
$72.20
|
| Rate for Payer: Central Health Plan Commercial |
$128.35
|
| Rate for Payer: Cigna of CA HMO |
$112.31
|
| Rate for Payer: Cigna of CA PPO |
$112.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.18
|
| Rate for Payer: Galaxy Health WC |
$136.37
|
| Rate for Payer: Global Benefits Group Commercial |
$96.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.09
|
| Rate for Payer: Multiplan Commercial |
$120.33
|
| Rate for Payer: Networks By Design Commercial |
$80.22
|
| Rate for Payer: Prime Health Services Commercial |
$136.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.58
|
| Rate for Payer: United Healthcare All Other HMO |
$59.17
|
| Rate for Payer: United Healthcare HMO Rider |
$57.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.95
|
|
|
HC COLLAR MIAMI J REPLACEMENT PAD
|
Facility
|
OP
|
$160.44
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901698555
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.15 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.79
|
| Rate for Payer: Blue Distinction Transplant |
$96.26
|
| Rate for Payer: Blue Shield of California Commercial |
$120.33
|
| Rate for Payer: Blue Shield of California EPN |
$87.28
|
| Rate for Payer: Cash Price |
$72.20
|
| Rate for Payer: Central Health Plan Commercial |
$128.35
|
| Rate for Payer: Cigna of CA HMO |
$112.31
|
| Rate for Payer: Cigna of CA PPO |
$112.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.37
|
| Rate for Payer: Dignity Health Media |
$136.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.18
|
| Rate for Payer: Galaxy Health WC |
$136.37
|
| Rate for Payer: Global Benefits Group Commercial |
$96.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.78
|
| Rate for Payer: Multiplan Commercial |
$120.33
|
| Rate for Payer: Networks By Design Commercial |
$80.22
|
| Rate for Payer: Prime Health Services Commercial |
$136.37
|
| Rate for Payer: Riverside University Health System MISP |
$64.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.22
|
| Rate for Payer: United Healthcare All Other HMO |
$80.22
|
| Rate for Payer: United Healthcare HMO Rider |
$80.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.37
|
| Rate for Payer: Vantage Medical Group Senior |
$136.37
|
|
|
HC COLLAR MIAMI J SM
|
Facility
|
OP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.28 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.56
|
| Rate for Payer: Blue Distinction Transplant |
$115.33
|
| Rate for Payer: Blue Shield of California Commercial |
$144.16
|
| Rate for Payer: Blue Shield of California EPN |
$104.57
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Central Health Plan Commercial |
$153.78
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.39
|
| Rate for Payer: Dignity Health Media |
$163.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$144.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.81
|
| Rate for Payer: Multiplan Commercial |
$144.16
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: Riverside University Health System MISP |
$76.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.11
|
| Rate for Payer: United Healthcare All Other HMO |
$96.11
|
| Rate for Payer: United Healthcare HMO Rider |
$96.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.39
|
| Rate for Payer: Vantage Medical Group Senior |
$163.39
|
|
|
HC COLLAR MIAMI J SM
|
Facility
|
IP
|
$192.22
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Blue Shield of California EPN |
$102.65
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Central Health Plan Commercial |
$153.78
|
| Rate for Payer: Cigna of CA HMO |
$134.55
|
| Rate for Payer: Cigna of CA PPO |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.89
|
| Rate for Payer: Galaxy Health WC |
$163.39
|
| Rate for Payer: Global Benefits Group Commercial |
$115.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.44
|
| Rate for Payer: Multiplan Commercial |
$144.16
|
| Rate for Payer: Networks By Design Commercial |
$96.11
|
| Rate for Payer: Prime Health Services Commercial |
$163.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.58
|
| Rate for Payer: United Healthcare All Other HMO |
$70.89
|
| Rate for Payer: United Healthcare HMO Rider |
$69.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.43
|
|
|
HC COLLAR MIAMI J STOUT
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Blue Shield of California EPN |
$182.23
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.86
|
| Rate for Payer: United Healthcare All Other HMO |
$125.85
|
| Rate for Payer: United Healthcare HMO Rider |
$123.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.61
|
|
|
HC COLLAR MIAMI J STOUT
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.44 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.61
|
| Rate for Payer: Blue Distinction Transplant |
$204.75
|
| Rate for Payer: Blue Shield of California Commercial |
$255.94
|
| Rate for Payer: Blue Shield of California EPN |
$185.64
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.06
|
| Rate for Payer: Dignity Health Media |
$290.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$255.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.91
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: Riverside University Health System MISP |
$136.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.62
|
| Rate for Payer: United Healthcare All Other HMO |
$170.62
|
| Rate for Payer: United Healthcare HMO Rider |
$170.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.06
|
| Rate for Payer: Vantage Medical Group Senior |
$290.06
|
|
|
HC COLLAR MIAMI J SUPER SHORT
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Blue Shield of California EPN |
$182.23
|
| Rate for Payer: Cash Price |
$153.56
|
| Rate for Payer: Central Health Plan Commercial |
$273.00
|
| Rate for Payer: Cigna of CA HMO |
$238.88
|
| Rate for Payer: Cigna of CA PPO |
$238.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.50
|
| Rate for Payer: Galaxy Health WC |
$290.06
|
| Rate for Payer: Global Benefits Group Commercial |
$204.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$255.94
|
| Rate for Payer: Networks By Design Commercial |
$170.62
|
| Rate for Payer: Prime Health Services Commercial |
$290.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.86
|
| Rate for Payer: United Healthcare All Other HMO |
$125.85
|
| Rate for Payer: United Healthcare HMO Rider |
$123.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.61
|
|
