|
HC PROTHROMBIN G20210A MUTATION
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Dignity Health Medi-Cal |
$72.26
|
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.26
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.60
|
| Rate for Payer: Blue Shield of California Commercial |
$430.75
|
| Rate for Payer: Blue Shield of California Commercial |
$114.31
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California Commercial |
$284.90
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna of CA HMO |
$104.96
|
| Rate for Payer: Cigna of CA HMO |
$395.52
|
| Rate for Payer: Cigna of CA PPO |
$457.32
|
| Rate for Payer: Cigna of CA PPO |
$121.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$432.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.39
|
| Rate for Payer: EPIC Health Plan Senior |
$72.26
|
| Rate for Payer: EPIC Health Plan Senior |
$72.26
|
| Rate for Payer: Galaxy Health WC |
$139.40
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$392.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.02
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.21
|
| 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 All Other HMO |
$53.21
|
| Rate for Payer: United Healthcare HMO Rider |
$53.21
|
| Rate for Payer: United Healthcare HMO Rider |
$53.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$65.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$65.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Vantage Medical Group Senior |
$65.69
|
| Rate for Payer: Vantage Medical Group Senior |
$65.69
|
|
|
HC PROTHROMBIN G20210A MUTATION
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$525.30 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$432.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$392.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.32
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.43
|
| 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 |
$40.65
|
| Rate for Payer: Blue Shield of California Commercial |
$56.24
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| 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 |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| 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: Upland Medical Group Pediatric |
$4.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC PROTHROMBIN TIME QUICK
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.72
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.65
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$56.24
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.47
|
| 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 All Other HMO |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
HC PROTHROMBIN TIME QUICK
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC PROTON COMPLEX
|
Facility
|
IP
|
$11,604.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,320.80 |
| Max. Negotiated Rate |
$9,863.40 |
| Rate for Payer: Adventist Health Commercial |
$2,320.80
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,122.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,641.60
|
| Rate for Payer: Galaxy Health WC |
$9,863.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,962.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,368.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,846.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,784.96
|
| Rate for Payer: Multiplan Commercial |
$9,283.20
|
| Rate for Payer: Networks By Design Commercial |
$7,542.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,863.40
|
|
|
HC PROTON COMPLEX
|
Facility
|
OP
|
$11,604.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,607.38 |
| 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 |
$2,411.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,607.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,607.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,023.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7,403.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4,885.28
|
| 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 |
$2,411.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,607.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,607.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,122.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,652.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.12
|
| 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/Senior |
$2,636.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,607.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,607.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,368.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,250.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,784.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,025.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,153.89
|
| 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 |
$2,411.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,607.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1,607.38
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,649.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,939.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,447.52
|
| 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 |
$1,607.38 |
| 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 |
$2,411.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,607.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,607.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,614.72
|
| Rate for Payer: Blue Shield of California Commercial |
$6,972.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,600.69
|
| 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 |
$2,411.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,607.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,607.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,649.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,652.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.12
|
| 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/Senior |
$2,636.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,607.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,607.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,939.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,250.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,622.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,025.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,153.89
|
| 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 |
$2,411.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,607.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1,607.38
|
|
|
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 |
$1,607.38 |
| 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 |
$2,411.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,607.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,607.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,055.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5,328.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,516.19
|
| 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 |
$2,411.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,607.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,607.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,846.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,652.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.12
|
| 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/Senior |
$2,636.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,607.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,607.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,303.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,250.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,025.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,153.89
|
| 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 |
$69,115.00
|
| 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 |
$2,411.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,607.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1,607.38
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,846.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,303.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,927.68
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,027.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,653.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,394.86
|
| 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 PROTON SIMPLE WO COMPENSATOR
|
Facility
|
OP
|
$5,754.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$710.66 |
| 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 |
$1,065.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$710.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,482.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,671.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,422.43
|
| 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 |
$1,065.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$710.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,027.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,172.59
|
| Rate for Payer: EPIC Health Plan Senior |
$781.73
|
| 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/Senior |
$1,165.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$710.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$710.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,653.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$895.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$952.28
|
| 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 |
$69,115.00
|
| 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 |
$1,065.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$710.66
|
| Rate for Payer: Vantage Medical Group Senior |
$710.66
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$878.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$796.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$740.45
|
| 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 |
$229.63 |
| Max. Negotiated Rate |
$1,066.75 |
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$1,066.75
|
| Rate for Payer: Adventist Health Commercial |
$251.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$805.33
|
| Rate for Payer: Blue Shield of California Commercial |
$528.36
|
| Rate for Payer: Blue Shield of California Commercial |
$800.69
|
| 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 |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$753.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$796.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$455.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.12
|
| 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 |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC PROVOX LIFE LARY TUBE 10/55 STANDARD
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900831802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$577.15 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$577.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$373.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$509.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.71
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cigna of CA HMO |
$434.56
|
| Rate for Payer: Cigna of CA PPO |
$502.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$577.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$577.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$577.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.60
|
| Rate for Payer: EPIC Health Plan Senior |
$271.60
|
| Rate for Payer: Galaxy Health WC |
$577.15
|
| Rate for Payer: Global Benefits Group Commercial |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$475.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$475.30
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$407.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$407.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.50
|
| Rate for Payer: United Healthcare All Other HMO |
$339.50
|
| Rate for Payer: United Healthcare HMO Rider |
$339.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$577.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$577.15
|
| Rate for Payer: Vantage Medical Group Senior |
$577.15
|
|
|
HC PROVOX LIFE LARY TUBE 10/55 STANDARD
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900831802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$577.15 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.60
|
| Rate for Payer: EPIC Health Plan Senior |
$271.60
|
| Rate for Payer: Galaxy Health WC |
$577.15
|
| Rate for Payer: Global Benefits Group Commercial |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.96
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
|
|
HC PROVOX LIFE LARYTUBE 12/36 STANDARD
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900831800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$577.15 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.60
|
| Rate for Payer: EPIC Health Plan Senior |
$271.60
|
| Rate for Payer: Galaxy Health WC |
$577.15
|
| Rate for Payer: Global Benefits Group Commercial |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.96
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
|
|
HC PROVOX LIFE LARYTUBE 12/36 STANDARD
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900831800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$577.15 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$577.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$373.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$509.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.71
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cigna of CA HMO |
$434.56
|
| Rate for Payer: Cigna of CA PPO |
$502.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$577.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$577.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$577.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.60
|
| Rate for Payer: EPIC Health Plan Senior |
$271.60
|
| Rate for Payer: Galaxy Health WC |
$577.15
|
| Rate for Payer: Global Benefits Group Commercial |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$475.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$475.30
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$407.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$407.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.50
|
| Rate for Payer: United Healthcare All Other HMO |
$339.50
|
| Rate for Payer: United Healthcare HMO Rider |
$339.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$577.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$577.15
|
| Rate for Payer: Vantage Medical Group Senior |
$577.15
|
|
|
HC PROVOX LIFE LARY TUBE 12/55 STANDARD
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900831803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$577.15 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.60
|
| Rate for Payer: EPIC Health Plan Senior |
$271.60
|
| Rate for Payer: Galaxy Health WC |
$577.15
|
| Rate for Payer: Global Benefits Group Commercial |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.96
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
|
|
HC PROVOX LIFE LARY TUBE 12/55 STANDARD
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900831803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$577.15 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$577.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$373.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$509.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.71
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cigna of CA HMO |
$434.56
|
| Rate for Payer: Cigna of CA PPO |
$502.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$577.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$577.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$577.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.60
|
| Rate for Payer: EPIC Health Plan Senior |
$271.60
|
| Rate for Payer: Galaxy Health WC |
$577.15
|
| Rate for Payer: Global Benefits Group Commercial |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$475.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$475.30
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$407.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$407.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.50
|
| Rate for Payer: United Healthcare All Other HMO |
$339.50
|
| Rate for Payer: United Healthcare HMO Rider |
$339.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$577.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$577.15
|
| Rate for Payer: Vantage Medical Group Senior |
$577.15
|
|
|
HC PROVOX LIFE LARY TUBE 9/55 STANDARD
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900831801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$577.15 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$577.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$373.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$509.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.71
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cigna of CA HMO |
$434.56
|
| Rate for Payer: Cigna of CA PPO |
$502.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$577.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$577.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$577.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.60
|
| Rate for Payer: EPIC Health Plan Senior |
$271.60
|
| Rate for Payer: Galaxy Health WC |
$577.15
|
| Rate for Payer: Global Benefits Group Commercial |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$475.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$475.30
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$407.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$407.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.50
|
| Rate for Payer: United Healthcare All Other HMO |
$339.50
|
| Rate for Payer: United Healthcare HMO Rider |
$339.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$577.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$577.15
|
| Rate for Payer: Vantage Medical Group Senior |
$577.15
|
|
|
HC PROVOX LIFE LARY TUBE 9/55 STANDARD
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900831801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$577.15 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.60
|
| Rate for Payer: EPIC Health Plan Senior |
$271.60
|
| Rate for Payer: Galaxy Health WC |
$577.15
|
| Rate for Payer: Global Benefits Group Commercial |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.96
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
|
|
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 |
$594.18 |
| Max. Negotiated Rate |
$6,617.25 |
| Rate for Payer: Adventist Health Commercial |
$1,557.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,106.18
|
| 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 |
$4,995.63
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$3,503.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,449.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,943.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,825.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,593.15
|
| 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
|
|
