|
HC PROTEIN TOTAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$33.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.41
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN TOTAL SPE ONLY
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$33.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.41
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900910290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$33.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.54
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTHROMBIN G20210A MUTATION
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$288.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$211.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.69
|
| Rate for Payer: Blue Distinction Transplant |
$100.80
|
| Rate for Payer: Blue Shield of California Commercial |
$108.53
|
| Rate for Payer: Blue Shield of California EPN |
$86.02
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.54
|
| Rate for Payer: Dignity Health Media |
$65.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.69
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$107.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$106.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.02
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.21
|
| Rate for Payer: United Healthcare All Other HMO |
$53.21
|
| Rate for Payer: United Healthcare HMO Rider |
$53.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Vantage Medical Group Senior |
$65.69
|
|
|
HC PROTHROMBIN G20210A MUTATION
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$151.68 |
| Max. Negotiated Rate |
$537.20 |
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: Galaxy Health WC |
$537.20
|
| Rate for Payer: Global Benefits Group Commercial |
$379.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$421.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.68
|
| Rate for Payer: Multiplan Commercial |
$505.60
|
| Rate for Payer: Networks By Design Commercial |
$410.80
|
| Rate for Payer: Prime Health Services Commercial |
$537.20
|
|
|
HC PROTHROMBIN TIME QUICK
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$35.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.93
|
| Rate for Payer: Blue Distinction Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.44
|
| Rate for Payer: Dignity Health Media |
$4.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
HC PROTON COMPLEX
|
Facility
|
OP
|
$14,371.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,772.43 |
| Max. Negotiated Rate |
$171,221.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,572.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,772.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,076.50
|
| Rate for Payer: Blue Distinction Transplant |
$8,622.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,493.26
|
| Rate for Payer: Blue Shield of California EPN |
$6,740.00
|
| Rate for Payer: Cash Price |
$6,466.95
|
| Rate for Payer: Cash Price |
$6,466.95
|
| Rate for Payer: Cash Price |
$6,466.95
|
| Rate for Payer: Cigna of CA HMO |
$8,622.60
|
| Rate for Payer: Cigna of CA PPO |
$8,622.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Dignity Health Media |
$1,772.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,772.43
|
| Rate for Payer: Galaxy Health WC |
$12,215.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,622.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,778.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,906.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,906.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,871.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,772.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,772.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,585.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,772.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,449.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,233.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,375.06
|
| Rate for Payer: Multiplan Commercial |
$11,496.80
|
| Rate for Payer: Networks By Design Commercial |
$8,622.60
|
| Rate for Payer: Prime Health Services Commercial |
$12,215.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$171,221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$122,553.00
|
| Rate for Payer: United Healthcare HMO Rider |
$116,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106,695.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,772.43
|
|
|
HC PROTON COMPLEX
|
Facility
|
IP
|
$14,371.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$3,449.04 |
| Max. Negotiated Rate |
$12,215.35 |
| Rate for Payer: Cash Price |
$6,466.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,748.40
|
| Rate for Payer: Galaxy Health WC |
$12,215.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,622.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,585.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,475.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,449.04
|
| Rate for Payer: Multiplan Commercial |
$11,496.80
|
| Rate for Payer: Networks By Design Commercial |
$9,341.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,215.35
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
IP
|
$13,533.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$3,247.92 |
| Max. Negotiated Rate |
$11,503.05 |
| Rate for Payer: Cash Price |
$6,089.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,413.20
|
| Rate for Payer: Galaxy Health WC |
$11,503.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,119.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,026.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,156.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,247.92
|
| Rate for Payer: Multiplan Commercial |
$10,826.40
|
| Rate for Payer: Networks By Design Commercial |
$8,796.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,503.05
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
OP
|
$13,533.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,772.43 |
| Max. Negotiated Rate |
$131,711.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,572.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,772.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,605.55
|
| Rate for Payer: Blue Distinction Transplant |
$8,119.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,998.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,346.98
|
| Rate for Payer: Cash Price |
$6,089.85
|
| Rate for Payer: Cash Price |
$6,089.85
|
| Rate for Payer: Cash Price |
$6,089.85
|
| Rate for Payer: Cigna of CA HMO |
$8,119.80
|
| Rate for Payer: Cigna of CA PPO |
$8,119.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Dignity Health Media |
$1,772.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,772.43
|
| Rate for Payer: Galaxy Health WC |
$11,503.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,119.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,149.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,906.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,906.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,871.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,772.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,772.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,026.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,772.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,247.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,233.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,375.06
|
| Rate for Payer: Multiplan Commercial |
$10,826.40
|
| Rate for Payer: Networks By Design Commercial |
$8,119.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,503.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131,711.00
|
| Rate for Payer: United Healthcare All Other HMO |
$94,270.00
|
| Rate for Payer: United Healthcare HMO Rider |
$89,754.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82,073.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,772.43
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
OP
|
$10,344.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,772.00 |
| Max. Negotiated Rate |
$96,586.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,772.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,813.33
|
| Rate for Payer: Blue Distinction Transplant |
$6,206.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,113.30
|
| Rate for Payer: Blue Shield of California EPN |
$4,851.34
|
| Rate for Payer: Cash Price |
$4,654.80
|
| Rate for Payer: Cash Price |
$4,654.80
|
| Rate for Payer: Cash Price |
$4,654.80
|
| Rate for Payer: Cigna of CA HMO |
$6,206.40
|
| Rate for Payer: Cigna of CA PPO |
$6,206.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Dignity Health Media |
$1,772.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,772.43
|
| Rate for Payer: Galaxy Health WC |
$8,792.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,206.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,758.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,906.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,906.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,871.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,772.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,772.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,772.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,482.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,233.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,375.06
|
| Rate for Payer: Multiplan Commercial |
$8,275.20
|
| Rate for Payer: Networks By Design Commercial |
$6,206.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,792.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$96,586.00
|
| Rate for Payer: United Healthcare All Other HMO |
$69,130.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65,824.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60,190.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,772.43
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
IP
|
$10,344.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,482.56 |
| Max. Negotiated Rate |
$8,792.40 |
| Rate for Payer: Cash Price |
$4,654.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,137.60
|
| Rate for Payer: Galaxy Health WC |
$8,792.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,206.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,899.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,941.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,482.56
|
| Rate for Payer: Multiplan Commercial |
$8,275.20
|
| Rate for Payer: Networks By Design Commercial |
$6,723.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,792.40
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
IP
|
$7,126.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,710.24 |
| Max. Negotiated Rate |
$6,057.10 |
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.40
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,715.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,710.24
|
| Rate for Payer: Multiplan Commercial |
$5,700.80
|
| Rate for Payer: Networks By Design Commercial |
$4,631.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
OP
|
$7,126.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$735.49 |
| Max. Negotiated Rate |
$96,586.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$735.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,004.81
|
| Rate for Payer: Blue Distinction Transplant |
$4,275.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,211.47
|
| Rate for Payer: Blue Shield of California EPN |
$3,342.09
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Cigna of CA HMO |
$4,275.60
|
| Rate for Payer: Cigna of CA PPO |
$4,275.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Media |
$735.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$735.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$735.49
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,344.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,206.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,206.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$735.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,710.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$985.56
|
| Rate for Payer: Multiplan Commercial |
$5,700.80
|
| Rate for Payer: Networks By Design Commercial |
$4,275.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$96,586.00
|
| Rate for Payer: United Healthcare All Other HMO |
$69,130.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65,824.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60,190.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$735.49
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$342.96 |
| Max. Negotiated Rate |
$1,214.65 |
| Rate for Payer: Cash Price |
$643.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.60
|
| Rate for Payer: Galaxy Health WC |
$1,214.65
|
| Rate for Payer: Global Benefits Group Commercial |
$857.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.96
|
| Rate for Payer: Multiplan Commercial |
$1,143.20
|
| Rate for Payer: Networks By Design Commercial |
$928.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,214.65
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$214.34 |
| Max. Negotiated Rate |
$1,214.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$214.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$851.40
|
| Rate for Payer: Blue Distinction Transplant |
$857.40
|
| Rate for Payer: Blue Shield of California Commercial |
$844.54
|
| Rate for Payer: Blue Shield of California EPN |
$670.20
|
| Rate for Payer: Cash Price |
$643.05
|
| Rate for Payer: Cash Price |
$643.05
|
| Rate for Payer: Cash Price |
$643.05
|
| Rate for Payer: Cigna of CA HMO |
$914.56
|
| Rate for Payer: Cigna of CA PPO |
$1,057.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,214.65
|
| Rate for Payer: Global Benefits Group Commercial |
$857.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,071.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,143.20
|
| Rate for Payer: Networks By Design Commercial |
$928.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,214.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$857.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$857.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.48 |
| Max. Negotiated Rate |
$1,085.45 |
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.80
|
| Rate for Payer: Galaxy Health WC |
$1,085.45
|
| Rate for Payer: Global Benefits Group Commercial |
$766.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.48
|
| Rate for Payer: Multiplan Commercial |
$1,021.60
|
| Rate for Payer: Networks By Design Commercial |
$830.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.45
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.10 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$766.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: Cigna of CA PPO |
$944.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$1,085.45
|
| Rate for Payer: Global Benefits Group Commercial |
$766.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$957.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$1,021.60
|
| Rate for Payer: Networks By Design Commercial |
$830.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$766.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC PSTNR ZFLO NEO CVR STRAPS 20"
|
Facility
|
OP
|
$128.59
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$109.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.61
|
| Rate for Payer: Blue Distinction Transplant |
$77.15
|
| Rate for Payer: Blue Shield of California Commercial |
$94.77
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Cigna of CA HMO |
$82.30
|
| Rate for Payer: Cigna of CA PPO |
$95.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.30
|
| Rate for Payer: Dignity Health Media |
$109.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.86
|
| Rate for Payer: Multiplan Commercial |
$102.87
|
| Rate for Payer: Networks By Design Commercial |
$83.58
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.30
|
| Rate for Payer: United Healthcare All Other HMO |
$64.30
|
| Rate for Payer: United Healthcare HMO Rider |
$64.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.30
|
| Rate for Payer: Vantage Medical Group Senior |
$109.30
|
|
|
HC PSTNR ZFLO NEO CVR STRAPS 20"
|
Facility
|
IP
|
$128.59
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$109.30 |
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.86
|
| Rate for Payer: Multiplan Commercial |
$102.87
|
| Rate for Payer: Networks By Design Commercial |
$83.58
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.53
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$257.95
|
| Rate for Payer: Blue Shield of California EPN |
$204.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
IP
|
$184.73
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$157.02 |
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.34
|
| Rate for Payer: Multiplan Commercial |
$147.78
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
OP
|
$184.73
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$157.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.06
|
| Rate for Payer: Blue Distinction Transplant |
$110.84
|
| Rate for Payer: Blue Shield of California Commercial |
$136.15
|
| Rate for Payer: Blue Shield of California EPN |
$107.88
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cigna of CA HMO |
$118.23
|
| Rate for Payer: Cigna of CA PPO |
$136.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.02
|
| Rate for Payer: Dignity Health Media |
$157.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$138.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.34
|
| Rate for Payer: Multiplan Commercial |
$147.78
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.36
|
| Rate for Payer: United Healthcare All Other HMO |
$92.36
|
| Rate for Payer: United Healthcare HMO Rider |
$92.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.02
|
| Rate for Payer: Vantage Medical Group Senior |
$157.02
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$220.20
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Media |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.50
|
| Rate for Payer: United Healthcare All Other HMO |
$183.50
|
| Rate for Payer: United Healthcare HMO Rider |
$183.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
