|
HC HEEL WEDGE SACH
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
905353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.89
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC HEEL WEDGE SACH
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
905353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC HEEL WEDGE SACH
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
915353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.89
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC HELIOX THERAPY PER DAY
|
Facility
|
IP
|
$3,537.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800410
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$707.40 |
| Max. Negotiated Rate |
$3,183.30 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,829.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,475.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,414.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,414.80
|
| Rate for Payer: Galaxy Health WC |
$3,006.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,122.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,183.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,245.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,086.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.40
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: Networks By Design Commercial |
$2,299.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,006.45
|
|
|
HC HELIOX THERAPY PER DAY
|
Facility
|
OP
|
$3,537.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800410
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$3,183.30 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,148.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,712.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,057.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,228.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,404.19
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,829.60
|
| Rate for Payer: Cigna of CA HMO |
$2,263.68
|
| Rate for Payer: Cigna of CA PPO |
$2,617.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,475.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$3,006.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,122.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,183.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,245.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: Networks By Design Commercial |
$2,299.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$3,006.45
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,122.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,122.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
905368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
915368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$385.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$259.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.21
|
| Rate for Payer: Blue Shield of California Commercial |
$339.19
|
| Rate for Payer: Blue Shield of California EPN |
$213.47
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Central Health Plan Commercial |
$428.00
|
| Rate for Payer: Cigna of CA HMO |
$342.40
|
| Rate for Payer: Cigna of CA PPO |
$395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$454.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$374.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$481.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$339.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
| Rate for Payer: Riverside University Health System MISP |
$214.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
905368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$385.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.82
|
| Rate for Payer: Blue Shield of California Commercial |
$297.35
|
| Rate for Payer: Blue Shield of California EPN |
$187.13
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Riverside University Health System MISP |
$187.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
|
HC HELMET HARD PROTECT PREFAB
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT A8001
|
| Hospital Charge Code |
915368001
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Central Health Plan Commercial |
$428.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$374.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$481.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$339.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
915350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,130.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,799.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,162.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,483.08
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Cigna of CA HMO |
$2,378.88
|
| Rate for Payer: Cigna of CA PPO |
$2,750.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,486.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
905350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
915350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
|
|
HC HELMET MOLDED TO PT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT A8002
|
| Hospital Charge Code |
905350100
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,130.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,799.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,162.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,483.08
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Cigna of CA HMO |
$2,378.88
|
| Rate for Payer: Cigna of CA PPO |
$2,750.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,486.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
915368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
905368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$385.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.82
|
| Rate for Payer: Blue Shield of California Commercial |
$297.35
|
| Rate for Payer: Blue Shield of California EPN |
$187.13
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Riverside University Health System MISP |
$187.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
905368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
915368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$385.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.82
|
| Rate for Payer: Blue Shield of California Commercial |
$297.35
|
| Rate for Payer: Blue Shield of California EPN |
$187.13
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Riverside University Health System MISP |
$187.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
|
HC HELMET SOFT SHELL 2X-SM TAN
|
Facility
|
IP
|
$518.23
|
|
| Hospital Charge Code |
901698208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.65 |
| Max. Negotiated Rate |
$466.41 |
| Rate for Payer: Adventist Health Commercial |
$103.65
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Central Health Plan Commercial |
$414.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.29
|
| Rate for Payer: EPIC Health Plan Senior |
$207.29
|
| Rate for Payer: Galaxy Health WC |
$440.50
|
| Rate for Payer: Global Benefits Group Commercial |
$310.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$466.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.65
|
| Rate for Payer: Multiplan Commercial |
$388.67
|
| Rate for Payer: Networks By Design Commercial |
$336.85
|
| Rate for Payer: Prime Health Services Commercial |
$440.50
|
|
|
HC HELMET SOFT SHELL 2X-SM TAN
|
Facility
|
OP
|
$518.23
|
|
| Hospital Charge Code |
901698208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.65 |
| Max. Negotiated Rate |
$466.41 |
| Rate for Payer: Adventist Health Commercial |
$103.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$440.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$285.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$250.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.45
|
| Rate for Payer: Blue Shield of California Commercial |
$328.56
|
| Rate for Payer: Blue Shield of California EPN |
$206.77
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Central Health Plan Commercial |
$414.58
|
| Rate for Payer: Cigna of CA HMO |
$331.67
|
| Rate for Payer: Cigna of CA PPO |
$383.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$440.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$440.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.29
|
| Rate for Payer: EPIC Health Plan Senior |
$207.29
|
| Rate for Payer: Galaxy Health WC |
$440.50
|
| Rate for Payer: Global Benefits Group Commercial |
$310.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$466.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$362.76
|
| Rate for Payer: Multiplan Commercial |
$388.67
|
| Rate for Payer: Networks By Design Commercial |
$336.85
|
| Rate for Payer: Prime Health Services Commercial |
$440.50
|
| Rate for Payer: Riverside University Health System MISP |
$207.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.12
|
| Rate for Payer: United Healthcare All Other HMO |
$259.12
|
| Rate for Payer: United Healthcare HMO Rider |
$259.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$440.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.50
|
| Rate for Payer: Vantage Medical Group Senior |
$440.50
|
|
|
HC HELMET SOFT SHELL LARGE
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901604758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$452.37 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$305.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$243.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.38
|
| Rate for Payer: Blue Shield of California Commercial |
$318.67
|
| Rate for Payer: Blue Shield of California EPN |
$200.55
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Central Health Plan Commercial |
$402.10
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$376.97
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Riverside University Health System MISP |
$201.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL LARGE
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901604758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$452.37 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Central Health Plan Commercial |
$402.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.53
|
| Rate for Payer: Multiplan Commercial |
$376.97
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL MED, TAN
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901698207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$452.37 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Central Health Plan Commercial |
$402.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.53
|
| Rate for Payer: Multiplan Commercial |
$376.97
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL MED, TAN
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901698207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$452.37 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$305.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$243.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.38
|
| Rate for Payer: Blue Shield of California Commercial |
$318.67
|
| Rate for Payer: Blue Shield of California EPN |
$200.55
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Central Health Plan Commercial |
$402.10
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$376.97
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Riverside University Health System MISP |
$201.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL SMALL,TAN
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901698206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$452.37 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Central Health Plan Commercial |
$402.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.53
|
| Rate for Payer: Multiplan Commercial |
$376.97
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL SMALL,TAN
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901698206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$452.37 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$305.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$243.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.38
|
| Rate for Payer: Blue Shield of California Commercial |
$318.67
|
| Rate for Payer: Blue Shield of California EPN |
$200.55
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Central Health Plan Commercial |
$402.10
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$376.97
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Riverside University Health System MISP |
$201.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
