|
HC PROTON COMPLEX
|
Facility
|
OP
|
$11,604.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,620.66 |
| Max. Negotiated Rate |
$180,381.00 |
| Rate for Payer: Adventist Health Commercial |
$2,320.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,572.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,721.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7,101.65
|
| Rate for Payer: Blue Shield of California EPN |
$4,688.02
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna of CA HMO |
$6,962.40
|
| Rate for Payer: Cigna of CA PPO |
$6,962.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1,620.66
|
| Rate for Payer: Galaxy Health WC |
$9,863.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,962.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,657.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,620.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,739.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,620.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,784.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,042.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,171.68
|
| Rate for Payer: Multiplan Commercial |
$9,283.20
|
| Rate for Payer: Networks By Design Commercial |
$6,962.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,863.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180,381.00
|
| Rate for Payer: United Healthcare All Other HMO |
$128,681.00
|
| Rate for Payer: United Healthcare HMO Rider |
$122,515.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112,243.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$55,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.66
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
IP
|
$10,928.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,185.60 |
| Max. Negotiated Rate |
$9,288.80 |
| Rate for Payer: Adventist Health Commercial |
$2,185.60
|
| Rate for Payer: Cash Price |
$4,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,371.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,371.20
|
| Rate for Payer: Galaxy Health WC |
$9,288.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,556.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,163.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,764.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,622.72
|
| Rate for Payer: Multiplan Commercial |
$8,742.40
|
| Rate for Payer: Networks By Design Commercial |
$7,103.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,288.80
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
OP
|
$10,928.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,620.66 |
| Max. Negotiated Rate |
$138,758.00 |
| Rate for Payer: Adventist Health Commercial |
$2,185.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,572.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,329.50
|
| Rate for Payer: Blue Shield of California Commercial |
$6,687.94
|
| Rate for Payer: Blue Shield of California EPN |
$4,414.91
|
| Rate for Payer: Cash Price |
$4,917.60
|
| Rate for Payer: Cash Price |
$4,917.60
|
| Rate for Payer: Cash Price |
$4,917.60
|
| Rate for Payer: Cigna of CA HMO |
$6,556.80
|
| Rate for Payer: Cigna of CA PPO |
$6,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1,620.66
|
| Rate for Payer: Galaxy Health WC |
$9,288.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,556.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,657.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,620.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,620.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,622.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,042.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,171.68
|
| Rate for Payer: Multiplan Commercial |
$8,742.40
|
| Rate for Payer: Networks By Design Commercial |
$6,556.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,288.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$138,758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$98,984.00
|
| Rate for Payer: United Healthcare HMO Rider |
$94,242.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86,341.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$45,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.66
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
IP
|
$8,352.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,670.40 |
| Max. Negotiated Rate |
$7,099.20 |
| Rate for Payer: Adventist Health Commercial |
$1,670.40
|
| Rate for Payer: Cash Price |
$3,758.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,340.80
|
| Rate for Payer: Galaxy Health WC |
$7,099.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,011.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,570.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,182.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,169.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.48
|
| Rate for Payer: Multiplan Commercial |
$6,681.60
|
| Rate for Payer: Networks By Design Commercial |
$5,428.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,099.20
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
OP
|
$8,352.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,620.66 |
| Max. Negotiated Rate |
$101,753.00 |
| Rate for Payer: Adventist Health Commercial |
$1,670.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,837.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5,111.42
|
| Rate for Payer: Blue Shield of California EPN |
$3,374.21
|
| Rate for Payer: Cash Price |
$3,758.40
|
| Rate for Payer: Cash Price |
$3,758.40
|
| Rate for Payer: Cash Price |
$3,758.40
|
| Rate for Payer: Cigna of CA HMO |
$5,011.20
|
| Rate for Payer: Cigna of CA PPO |
$5,011.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1,620.66
|
| Rate for Payer: Galaxy Health WC |
$7,099.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,011.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,657.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,620.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,570.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,620.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,042.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,171.68
|
| Rate for Payer: Multiplan Commercial |
$6,681.60
|
| Rate for Payer: Networks By Design Commercial |
$5,011.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,099.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$72,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68,115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63,320.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$25,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.66
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
OP
|
$5,754.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$101,753.00 |
| Rate for Payer: Adventist Health Commercial |
$1,150.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$735.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,332.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3,521.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,324.62
|
| Rate for Payer: Cash Price |
$2,589.30
|
| Rate for Payer: Cash Price |
$2,589.30
|
| Rate for Payer: Cash Price |
$2,589.30
|
| Rate for Payer: Cigna of CA HMO |
$3,452.40
|
| Rate for Payer: Cigna of CA PPO |
$3,452.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$735.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$4,890.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,452.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$735.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$4,603.20
|
| Rate for Payer: Networks By Design Commercial |
$3,452.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$72,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68,115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63,320.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$25,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$735.00
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
IP
|
$5,754.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,150.80 |
| Max. Negotiated Rate |
$4,890.90 |
| Rate for Payer: Adventist Health Commercial |
$1,150.80
|
| Rate for Payer: Cash Price |
$2,589.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,301.60
|
| Rate for Payer: Galaxy Health WC |
$4,890.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,452.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,192.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,561.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.96
|
| Rate for Payer: Multiplan Commercial |
$4,603.20
|
| Rate for Payer: Networks By Design Commercial |
$3,740.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.90
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$1,066.75 |
| Rate for Payer: Adventist Health Commercial |
$251.00
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.00
|
| Rate for Payer: EPIC Health Plan Senior |
$502.00
|
| Rate for Payer: Galaxy Health WC |
$1,066.75
|
| Rate for Payer: Global Benefits Group Commercial |
$753.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$837.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$776.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.20
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: Networks By Design Commercial |
$815.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,066.75
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$1,066.75 |
| Rate for Payer: Adventist Health Commercial |
$251.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$823.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$770.70
|
| Rate for Payer: Blue Shield of California Commercial |
$768.06
|
| Rate for Payer: Blue Shield of California EPN |
$507.02
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna of CA HMO |
$803.20
|
| Rate for Payer: Cigna of CA PPO |
$928.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,066.75
|
| Rate for Payer: Global Benefits Group Commercial |
$753.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$837.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: Networks By Design Commercial |
$815.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,066.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$753.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$753.00
|
| 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 |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC PRQ TCAT THER RX NTRAC BLLN SEP TRGT LESION
|
Facility
|
OP
|
$7,785.00
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
906811502
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,557.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,617.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,281.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,838.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,780.77
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$3,503.25
|
| Rate for Payer: Cash Price |
$3,503.25
|
| Rate for Payer: Cigna of CA HMO |
$4,982.40
|
| Rate for Payer: Cigna of CA PPO |
$5,760.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,617.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,617.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,617.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,114.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,114.00
|
| Rate for Payer: Galaxy Health WC |
$6,617.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,671.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,192.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,966.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,818.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,449.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,449.50
|
| Rate for Payer: Multiplan Commercial |
$6,228.00
|
| Rate for Payer: Networks By Design Commercial |
$5,060.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,617.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,671.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,671.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,617.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,617.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,617.25
|
|
|
HC PRQ TCAT THER RX NTRAC BLLN SEP TRGT LESION
|
Facility
|
IP
|
$7,785.00
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
906811502
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,557.00 |
| Max. Negotiated Rate |
$6,617.25 |
| Rate for Payer: Adventist Health Commercial |
$1,557.00
|
| Rate for Payer: Cash Price |
$3,503.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,114.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,114.00
|
| Rate for Payer: Galaxy Health WC |
$6,617.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,671.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,192.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,966.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,818.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.40
|
| Rate for Payer: Multiplan Commercial |
$6,228.00
|
| Rate for Payer: Networks By Design Commercial |
$5,060.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,617.25
|
|
|
HC PRQ TCAT THER RX NTRAC BLLN SINGLE ARTERY OR BRANCH
|
Facility
|
IP
|
$15,570.00
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
906811501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,114.00 |
| Max. Negotiated Rate |
$13,234.50 |
| Rate for Payer: Adventist Health Commercial |
$3,114.00
|
| Rate for Payer: Cash Price |
$7,006.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,228.00
|
| Rate for Payer: Galaxy Health WC |
$13,234.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,385.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,932.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,637.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,736.80
|
| Rate for Payer: Multiplan Commercial |
$12,456.00
|
| Rate for Payer: Networks By Design Commercial |
$10,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,234.50
|
|
|
HC PRQ TCAT THER RX NTRAC BLLN SINGLE ARTERY OR BRANCH
|
Facility
|
OP
|
$15,570.00
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
906811501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$13,234.50 |
| Rate for Payer: Adventist Health Commercial |
$3,114.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,561.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$7,006.50
|
| Rate for Payer: Cash Price |
$7,006.50
|
| Rate for Payer: Cash Price |
$7,006.50
|
| Rate for Payer: Cigna of CA HMO |
$9,964.80
|
| Rate for Payer: Cigna of CA PPO |
$11,521.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$13,234.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,342.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,385.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,932.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,736.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$12,456.00
|
| Rate for Payer: Networks By Design Commercial |
$10,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,234.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PRTCTR HEEL HEELMEDIX PETITE
|
Facility
|
OP
|
$238.49
|
|
| Hospital Charge Code |
901606282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$202.72 |
| Rate for Payer: Adventist Health Commercial |
$47.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.46
|
| Rate for Payer: Cash Price |
$107.32
|
| Rate for Payer: Cigna of CA HMO |
$152.63
|
| Rate for Payer: Cigna of CA PPO |
$176.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$202.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$202.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.40
|
| Rate for Payer: EPIC Health Plan Senior |
$95.40
|
| Rate for Payer: Galaxy Health WC |
$202.72
|
| Rate for Payer: Global Benefits Group Commercial |
$143.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.94
|
| Rate for Payer: Multiplan Commercial |
$190.79
|
| Rate for Payer: Networks By Design Commercial |
$155.02
|
| Rate for Payer: Prime Health Services Commercial |
$202.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.25
|
| Rate for Payer: United Healthcare All Other HMO |
$119.25
|
| Rate for Payer: United Healthcare HMO Rider |
$119.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$202.72
|
| Rate for Payer: Vantage Medical Group Senior |
$202.72
|
|
|
HC PRTCTR HEEL HEELMEDIX PETITE
|
Facility
|
IP
|
$238.49
|
|
| Hospital Charge Code |
901606282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$202.72 |
| Rate for Payer: Adventist Health Commercial |
$47.70
|
| Rate for Payer: Cash Price |
$107.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.40
|
| Rate for Payer: EPIC Health Plan Senior |
$95.40
|
| Rate for Payer: Galaxy Health WC |
$202.72
|
| Rate for Payer: Global Benefits Group Commercial |
$143.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.24
|
| Rate for Payer: Multiplan Commercial |
$190.79
|
| Rate for Payer: Networks By Design Commercial |
$155.02
|
| Rate for Payer: Prime Health Services Commercial |
$202.72
|
|
|
HC PRTCTR HEEL HEELMEDIX STRD
|
Facility
|
IP
|
$302.82
|
|
| Hospital Charge Code |
901606281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Adventist Health Commercial |
$60.56
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.13
|
| Rate for Payer: EPIC Health Plan Senior |
$121.13
|
| Rate for Payer: Galaxy Health WC |
$257.40
|
| Rate for Payer: Global Benefits Group Commercial |
$181.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$242.26
|
| Rate for Payer: Networks By Design Commercial |
$196.83
|
| Rate for Payer: Prime Health Services Commercial |
$257.40
|
|
|
HC PRTCTR HEEL HEELMEDIX STRD
|
Facility
|
OP
|
$302.82
|
|
| Hospital Charge Code |
901606281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Adventist Health Commercial |
$60.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$198.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.96
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cigna of CA HMO |
$193.80
|
| Rate for Payer: Cigna of CA PPO |
$224.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.13
|
| Rate for Payer: EPIC Health Plan Senior |
$121.13
|
| Rate for Payer: Galaxy Health WC |
$257.40
|
| Rate for Payer: Global Benefits Group Commercial |
$181.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$211.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$211.97
|
| Rate for Payer: Multiplan Commercial |
$242.26
|
| Rate for Payer: Networks By Design Commercial |
$196.83
|
| Rate for Payer: Prime Health Services Commercial |
$257.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.41
|
| Rate for Payer: United Healthcare All Other HMO |
$151.41
|
| Rate for Payer: United Healthcare HMO Rider |
$151.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.40
|
| Rate for Payer: Vantage Medical Group Senior |
$257.40
|
|
|
HC PRT FT MOLD SKT ANKL HI TOE FL
|
Facility
|
OP
|
$2,983.00
|
|
|
Service Code
|
CPT L5010
|
| Hospital Charge Code |
915355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$715.92 |
| Max. Negotiated Rate |
$2,535.55 |
| Rate for Payer: Adventist Health Commercial |
$1,223.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,535.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,640.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,237.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,727.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,201.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,449.74
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cigna of CA HMO |
$2,088.10
|
| Rate for Payer: Cigna of CA PPO |
$2,088.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,535.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,535.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,535.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,193.20
|
| Rate for Payer: Galaxy Health WC |
$2,535.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,789.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$938.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,846.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,088.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,088.10
|
| Rate for Payer: Multiplan Commercial |
$2,386.40
|
| Rate for Payer: Networks By Design Commercial |
$1,491.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,535.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,789.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,789.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,119.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$976.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,535.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,535.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,535.55
|
|
|
HC PRT FT MOLD SKT ANKL HI TOE FL
|
Facility
|
IP
|
$2,983.00
|
|
|
Service Code
|
CPT L5010
|
| Hospital Charge Code |
905355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$596.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$596.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cigna of CA HMO |
$2,088.10
|
| Rate for Payer: Cigna of CA PPO |
$2,088.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,193.20
|
| Rate for Payer: Galaxy Health WC |
$2,535.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,789.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,846.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.92
|
| Rate for Payer: Multiplan Commercial |
$2,386.40
|
| Rate for Payer: Networks By Design Commercial |
$1,491.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,535.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,119.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$976.93
|
|
|
HC PRT FT MOLD SKT ANKL HI TOE FL
|
Facility
|
IP
|
$2,983.00
|
|
|
Service Code
|
CPT L5010
|
| Hospital Charge Code |
915355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$596.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$596.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cigna of CA HMO |
$2,088.10
|
| Rate for Payer: Cigna of CA PPO |
$2,088.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,193.20
|
| Rate for Payer: Galaxy Health WC |
$2,535.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,789.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,846.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.92
|
| Rate for Payer: Multiplan Commercial |
$2,386.40
|
| Rate for Payer: Networks By Design Commercial |
$1,491.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,535.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,119.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$976.93
|
|
|
HC PRT FT MOLD SKT ANKL HI TOE FL
|
Facility
|
OP
|
$2,983.00
|
|
|
Service Code
|
CPT L5010
|
| Hospital Charge Code |
905355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$715.92 |
| Max. Negotiated Rate |
$2,535.55 |
| Rate for Payer: Adventist Health Commercial |
$1,223.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,535.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,640.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,237.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,727.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,201.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,449.74
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cigna of CA HMO |
$2,088.10
|
| Rate for Payer: Cigna of CA PPO |
$2,088.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,535.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,535.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,535.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,193.20
|
| Rate for Payer: Galaxy Health WC |
$2,535.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,789.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$938.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,846.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,088.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,088.10
|
| Rate for Payer: Multiplan Commercial |
$2,386.40
|
| Rate for Payer: Networks By Design Commercial |
$1,491.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,535.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,789.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,789.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,119.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$976.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,535.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,535.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,535.55
|
|
|
HC PRT FT MOLD SKT TIB TUBERCLE
|
Facility
|
OP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
915355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,017.84 |
| Max. Negotiated Rate |
$3,604.85 |
| Rate for Payer: Adventist Health Commercial |
$1,738.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,180.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,456.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,129.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,061.13
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cigna of CA HMO |
$2,968.70
|
| Rate for Payer: Cigna of CA PPO |
$2,968.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,604.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,604.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,696.40
|
| Rate for Payer: Galaxy Health WC |
$3,604.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,544.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,077.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,349.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,968.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,968.70
|
| Rate for Payer: Multiplan Commercial |
$3,392.80
|
| Rate for Payer: Networks By Design Commercial |
$2,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,544.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,544.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,591.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,549.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,515.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,388.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,604.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,604.85
|
|
|
HC PRT FT MOLD SKT TIB TUBERCLE
|
Facility
|
IP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
905355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$848.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$848.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cigna of CA HMO |
$2,968.70
|
| Rate for Payer: Cigna of CA PPO |
$2,968.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,696.40
|
| Rate for Payer: Galaxy Health WC |
$3,604.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,544.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,615.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.84
|
| Rate for Payer: Multiplan Commercial |
$3,392.80
|
| Rate for Payer: Networks By Design Commercial |
$2,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,591.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,549.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,515.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,388.93
|
|
|
HC PRT FT MOLD SKT TIB TUBERCLE
|
Facility
|
OP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
905355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,017.84 |
| Max. Negotiated Rate |
$3,604.85 |
| Rate for Payer: Adventist Health Commercial |
$1,738.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,180.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,456.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,129.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,061.13
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cigna of CA HMO |
$2,968.70
|
| Rate for Payer: Cigna of CA PPO |
$2,968.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,604.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,604.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,696.40
|
| Rate for Payer: Galaxy Health WC |
$3,604.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,544.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,077.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,349.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,968.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,968.70
|
| Rate for Payer: Multiplan Commercial |
$3,392.80
|
| Rate for Payer: Networks By Design Commercial |
$2,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,544.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,544.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,591.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,549.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,515.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,388.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,604.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,604.85
|
|
|
HC PRT FT MOLD SKT TIB TUBERCLE
|
Facility
|
IP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
915355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$848.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$848.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cigna of CA HMO |
$2,968.70
|
| Rate for Payer: Cigna of CA PPO |
$2,968.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,696.40
|
| Rate for Payer: Galaxy Health WC |
$3,604.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,544.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,615.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.84
|
| Rate for Payer: Multiplan Commercial |
$3,392.80
|
| Rate for Payer: Networks By Design Commercial |
$2,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,591.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,549.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,515.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,388.93
|
|
