|
HC COLLAR MIAMI J SUPER SHORT
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901605405
|
|
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 UNIVERSAL
|
Facility
|
OP
|
$368.30
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698554
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$347.57 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$178.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.59
|
| Rate for Payer: Blue Distinction Transplant |
$220.98
|
| Rate for Payer: Blue Shield of California Commercial |
$276.22
|
| Rate for Payer: Blue Shield of California EPN |
$200.36
|
| Rate for Payer: Cash Price |
$165.74
|
| Rate for Payer: Cash Price |
$165.74
|
| Rate for Payer: Central Health Plan Commercial |
$294.64
|
| Rate for Payer: Cigna of CA HMO |
$257.81
|
| Rate for Payer: Cigna of CA PPO |
$257.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.06
|
| Rate for Payer: Dignity Health Media |
$313.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$147.32
|
| Rate for Payer: Galaxy Health WC |
$313.06
|
| Rate for Payer: Global Benefits Group Commercial |
$220.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$276.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: Networks By Design Commercial |
$184.15
|
| Rate for Payer: Prime Health Services Commercial |
$313.06
|
| Rate for Payer: Riverside University Health System MISP |
$147.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.15
|
| Rate for Payer: United Healthcare All Other HMO |
$184.15
|
| Rate for Payer: United Healthcare HMO Rider |
$184.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.06
|
| Rate for Payer: Vantage Medical Group Senior |
$313.06
|
|
|
HC COLLAR MIAMI J UNIVERSAL
|
Facility
|
IP
|
$368.30
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901698554
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.66 |
| Max. Negotiated Rate |
$331.47 |
| Rate for Payer: Blue Shield of California EPN |
$196.67
|
| Rate for Payer: Cash Price |
$165.74
|
| Rate for Payer: Central Health Plan Commercial |
$294.64
|
| Rate for Payer: Cigna of CA HMO |
$257.81
|
| Rate for Payer: Cigna of CA PPO |
$257.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$147.32
|
| Rate for Payer: Galaxy Health WC |
$313.06
|
| Rate for Payer: Global Benefits Group Commercial |
$220.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.66
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: Networks By Design Commercial |
$184.15
|
| Rate for Payer: Prime Health Services Commercial |
$313.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.07
|
| Rate for Payer: United Healthcare All Other HMO |
$135.83
|
| Rate for Payer: United Healthcare HMO Rider |
$132.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.54
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
905350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.60
|
| Rate for Payer: Blue Distinction Transplant |
$195.60
|
| Rate for Payer: Blue Shield of California Commercial |
$244.50
|
| Rate for Payer: Blue Shield of California EPN |
$177.34
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Central Health Plan Commercial |
$260.80
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.10
|
| Rate for Payer: Dignity Health Media |
$277.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$244.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$114.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.66
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: Networks By Design Commercial |
$163.00
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Riverside University Health System MISP |
$130.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.00
|
| Rate for Payer: United Healthcare All Other HMO |
$163.00
|
| Rate for Payer: United Healthcare HMO Rider |
$163.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.10
|
| Rate for Payer: Vantage Medical Group Senior |
$277.10
|
|
|
HC COLLAR MOLDED CHIN CUP
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT L0150
|
| Hospital Charge Code |
905350150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Blue Shield of California EPN |
$174.08
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Central Health Plan Commercial |
$260.80
|
| Rate for Payer: Cigna of CA HMO |
$228.20
|
| Rate for Payer: Cigna of CA PPO |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: Networks By Design Commercial |
$163.00
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.10
|
| Rate for Payer: United Healthcare All Other HMO |
$120.23
|
| Rate for Payer: United Healthcare HMO Rider |
$117.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.58
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
905350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$493.49 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$998.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$878.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.30
|
| Rate for Payer: Blue Distinction Transplant |
$1,089.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,361.25
|
| Rate for Payer: Blue Shield of California EPN |
$987.36
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,452.00
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Dignity Health Media |
$1,542.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,542.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,633.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,361.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$635.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.15
|
| Rate for Payer: Multiplan Commercial |
$1,361.25
|
| Rate for Payer: Networks By Design Commercial |
$907.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: Riverside University Health System MISP |
$726.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,089.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,089.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.50
|
| Rate for Payer: United Healthcare All Other HMO |
$907.50
|
| Rate for Payer: United Healthcare HMO Rider |
$907.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.75
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
IP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
905350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Blue Shield of California EPN |
$969.21
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,452.00
|
| Rate for Payer: Cigna of CA HMO |
$1,270.50
|
| Rate for Payer: Cigna of CA PPO |
$1,270.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$726.00
|
| Rate for Payer: Galaxy Health WC |
$1,542.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,089.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,633.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,210.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$1,361.25
|
| Rate for Payer: Networks By Design Commercial |
$907.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,542.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$685.34
|
| Rate for Payer: United Healthcare All Other HMO |
$669.37
|
| Rate for Payer: United Healthcare HMO Rider |
$654.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$598.95
|
|
|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
905350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$456.75 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$717.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$631.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$770.99
|
| Rate for Payer: Blue Distinction Transplant |
$783.00
|
| Rate for Payer: Blue Shield of California Commercial |
$978.75
|
| Rate for Payer: Blue Shield of California EPN |
$709.92
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,044.00
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,109.25
|
| Rate for Payer: Dignity Health Media |
$1,109.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,174.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$978.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$456.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.05
|
| Rate for Payer: Multiplan Commercial |
$978.75
|
| Rate for Payer: Networks By Design Commercial |
$652.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: Riverside University Health System MISP |
$522.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$652.50
|
| Rate for Payer: United Healthcare All Other HMO |
$652.50
|
| Rate for Payer: United Healthcare HMO Rider |
$652.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$652.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,109.25
|
|
|
HC COLLAR MULTIPOST THORACIC EXT.
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
CPT L0200
|
| Hospital Charge Code |
905350200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Blue Shield of California EPN |
$696.87
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,044.00
|
| Rate for Payer: Cigna of CA HMO |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$913.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,174.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$978.75
|
| Rate for Payer: Networks By Design Commercial |
$652.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$492.77
|
| Rate for Payer: United Healthcare All Other HMO |
$481.28
|
| Rate for Payer: United Healthcare HMO Rider |
$470.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$430.65
|
|
|
HC COLLAR PHILADELPHIA 3 1/4 MED
|
Facility
|
IP
|
$99.86
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$89.87 |
| Rate for Payer: Blue Shield of California EPN |
$53.33
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Central Health Plan Commercial |
$79.89
|
| Rate for Payer: Cigna of CA HMO |
$69.90
|
| Rate for Payer: Cigna of CA PPO |
$69.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.94
|
| Rate for Payer: Galaxy Health WC |
$84.88
|
| Rate for Payer: Global Benefits Group Commercial |
$59.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.97
|
| Rate for Payer: Multiplan Commercial |
$74.90
|
| Rate for Payer: Networks By Design Commercial |
$49.93
|
| Rate for Payer: Prime Health Services Commercial |
$84.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.71
|
| Rate for Payer: United Healthcare All Other HMO |
$36.83
|
| Rate for Payer: United Healthcare HMO Rider |
$36.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.95
|
|
|
HC COLLAR PHILADELPHIA 3 1/4 MED
|
Facility
|
OP
|
$99.86
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$172.54 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.00
|
| Rate for Payer: Blue Distinction Transplant |
$59.92
|
| Rate for Payer: Blue Shield of California Commercial |
$74.90
|
| Rate for Payer: Blue Shield of California EPN |
$54.32
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Central Health Plan Commercial |
$79.89
|
| Rate for Payer: Cigna of CA HMO |
$69.90
|
| Rate for Payer: Cigna of CA PPO |
$69.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.88
|
| Rate for Payer: Dignity Health Media |
$84.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.94
|
| Rate for Payer: Galaxy Health WC |
$84.88
|
| Rate for Payer: Global Benefits Group Commercial |
$59.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$74.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.94
|
| Rate for Payer: Multiplan Commercial |
$74.90
|
| Rate for Payer: Networks By Design Commercial |
$49.93
|
| Rate for Payer: Prime Health Services Commercial |
$84.88
|
| Rate for Payer: Riverside University Health System MISP |
$39.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.93
|
| Rate for Payer: United Healthcare All Other HMO |
$49.93
|
| Rate for Payer: United Healthcare HMO Rider |
$49.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.88
|
| Rate for Payer: Vantage Medical Group Senior |
$84.88
|
|
|
HC COLLAR PHILADELPHIA 4 1/4 MED
|
Facility
|
OP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$172.54 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.04
|
| Rate for Payer: Blue Distinction Transplant |
$59.96
|
| Rate for Payer: Blue Shield of California Commercial |
$74.96
|
| Rate for Payer: Blue Shield of California EPN |
$54.37
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.95
|
| Rate for Payer: Dignity Health Media |
$84.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$74.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.98
|
| Rate for Payer: Multiplan Commercial |
$74.96
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: Riverside University Health System MISP |
$39.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.97
|
| Rate for Payer: United Healthcare All Other HMO |
$49.97
|
| Rate for Payer: United Healthcare HMO Rider |
$49.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.95
|
| Rate for Payer: Vantage Medical Group Senior |
$84.95
|
|
|
HC COLLAR PHILADELPHIA 4 1/4 MED
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Blue Shield of California EPN |
$53.37
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.99
|
| Rate for Payer: Multiplan Commercial |
$74.96
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.74
|
| Rate for Payer: United Healthcare All Other HMO |
$36.86
|
| Rate for Payer: United Healthcare HMO Rider |
$36.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.98
|
|
|
HC COLLAR PHILADELPHIA 5 1/4 MED
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Blue Shield of California EPN |
$53.37
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.99
|
| Rate for Payer: Multiplan Commercial |
$74.96
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.74
|
| Rate for Payer: United Healthcare All Other HMO |
$36.86
|
| Rate for Payer: United Healthcare HMO Rider |
$36.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.98
|
|
|
HC COLLAR PHILADELPHIA 5 1/4 MED
|
Facility
|
OP
|
$99.94
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
901603966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$172.54 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.04
|
| Rate for Payer: Blue Distinction Transplant |
$59.96
|
| Rate for Payer: Blue Shield of California Commercial |
$74.96
|
| Rate for Payer: Blue Shield of California EPN |
$54.37
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.95
|
| Rate for Payer: Dignity Health Media |
$84.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$74.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.98
|
| Rate for Payer: Multiplan Commercial |
$74.96
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: Riverside University Health System MISP |
$39.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.97
|
| Rate for Payer: United Healthcare All Other HMO |
$49.97
|
| Rate for Payer: United Healthcare HMO Rider |
$49.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.95
|
| Rate for Payer: Vantage Medical Group Senior |
$84.95
|
|
|
HC COLLAR PLASTIC FLEXIBLE MOLDED
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT L0130
|
| Hospital Charge Code |
905350130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Blue Shield of California EPN |
$138.31
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: Cigna of CA HMO |
$181.30
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$129.50
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.80
|
| Rate for Payer: United Healthcare All Other HMO |
$95.52
|
| Rate for Payer: United Healthcare HMO Rider |
$93.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.47
|
|
|
HC COLLAR PLASTIC FLEXIBLE MOLDED
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT L0130
|
| Hospital Charge Code |
905350130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.02
|
| Rate for Payer: Blue Distinction Transplant |
$155.40
|
| Rate for Payer: Blue Shield of California Commercial |
$194.25
|
| Rate for Payer: Blue Shield of California EPN |
$140.90
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: Cigna of CA HMO |
$181.30
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Media |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$194.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.19
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$129.50
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Riverside University Health System MISP |
$103.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$129.50
|
| Rate for Payer: United Healthcare HMO Rider |
$129.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC COLLAR PLASTIC SEMI-RIGID
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT L0140
|
| Hospital Charge Code |
905350140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.24 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.79
|
| Rate for Payer: Blue Distinction Transplant |
$157.20
|
| Rate for Payer: Blue Shield of California Commercial |
$196.50
|
| Rate for Payer: Blue Shield of California EPN |
$142.53
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Cigna of CA HMO |
$183.40
|
| Rate for Payer: Cigna of CA PPO |
$183.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.70
|
| Rate for Payer: Dignity Health Media |
$222.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$196.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.42
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$131.00
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Riverside University Health System MISP |
$104.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.00
|
| Rate for Payer: United Healthcare All Other HMO |
$131.00
|
| Rate for Payer: United Healthcare HMO Rider |
$131.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.70
|
| Rate for Payer: Vantage Medical Group Senior |
$222.70
|
|
|
HC COLLAR PLASTIC SEMI-RIGID
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT L0140
|
| Hospital Charge Code |
905350140
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Blue Shield of California EPN |
$139.91
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Cigna of CA HMO |
$183.40
|
| Rate for Payer: Cigna of CA PPO |
$183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.40
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$131.00
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.93
|
| Rate for Payer: United Healthcare All Other HMO |
$96.63
|
| Rate for Payer: United Healthcare HMO Rider |
$94.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC COLLAR SEMI-RIGID 2-PIECE FOAM
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
905350172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Blue Shield of California EPN |
$167.68
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: Cigna of CA HMO |
$219.80
|
| Rate for Payer: Cigna of CA PPO |
$219.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$157.00
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.57
|
| Rate for Payer: United Healthcare All Other HMO |
$115.80
|
| Rate for Payer: United Healthcare HMO Rider |
$113.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.62
|
|
|
HC COLLAR SEMI-RIGID 2-PIECE FOAM
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT L0172
|
| Hospital Charge Code |
905350172
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$266.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$152.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.51
|
| Rate for Payer: Blue Distinction Transplant |
$188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$235.50
|
| Rate for Payer: Blue Shield of California EPN |
$170.82
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: Cigna of CA HMO |
$219.80
|
| Rate for Payer: Cigna of CA PPO |
$219.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$266.90
|
| Rate for Payer: Dignity Health Media |
$266.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$266.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$235.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.74
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$157.00
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Riverside University Health System MISP |
$125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.00
|
| Rate for Payer: United Healthcare All Other HMO |
$157.00
|
| Rate for Payer: United Healthcare HMO Rider |
$157.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$266.90
|
| Rate for Payer: Vantage Medical Group Senior |
$266.90
|
|
|
HC COLLAR SEMI-RIGID WIRE FRAME
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT L0160
|
| Hospital Charge Code |
905350160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$412.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$266.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$234.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.54
|
| Rate for Payer: Blue Distinction Transplant |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$363.75
|
| Rate for Payer: Blue Shield of California EPN |
$263.84
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Central Health Plan Commercial |
$388.00
|
| Rate for Payer: Cigna of CA HMO |
$339.50
|
| Rate for Payer: Cigna of CA PPO |
$339.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$412.25
|
| Rate for Payer: Dignity Health Media |
$412.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$436.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$363.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$169.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.85
|
| Rate for Payer: Multiplan Commercial |
$363.75
|
| Rate for Payer: Networks By Design Commercial |
$242.50
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
| Rate for Payer: Riverside University Health System MISP |
$194.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.50
|
| Rate for Payer: United Healthcare All Other HMO |
$242.50
|
| Rate for Payer: United Healthcare HMO Rider |
$242.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$242.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.25
|
| Rate for Payer: Vantage Medical Group Senior |
$412.25
|
|
|
HC COLLAR SEMI-RIGID WIRE FRAME
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT L0160
|
| Hospital Charge Code |
905350160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Blue Shield of California EPN |
$258.99
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Central Health Plan Commercial |
$388.00
|
| Rate for Payer: Cigna of CA HMO |
$339.50
|
| Rate for Payer: Cigna of CA PPO |
$339.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$436.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.00
|
| Rate for Payer: Multiplan Commercial |
$363.75
|
| Rate for Payer: Networks By Design Commercial |
$242.50
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.14
|
| Rate for Payer: United Healthcare All Other HMO |
$178.87
|
| Rate for Payer: United Healthcare HMO Rider |
$174.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.05
|
|
|
HC COLLECT BLOOD FROM ESTAB DEVICE
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
945100108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Central Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$310.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
|
HC COLLECT BLOOD FROM ESTAB DEVICE
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
910100057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Central Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$310.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
