|
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: 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 Medicare Advantage |
$4,593.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,899.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,886.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,186.30
|
| 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 |
$594.18 |
| Max. Negotiated Rate |
$24,498.80 |
| Rate for Payer: Adventist Health Commercial |
$3,114.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,212.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,991.27
|
| 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 |
$7,006.50
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,899.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,886.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,651.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,736.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.94
|
| 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 Foundation Hospitals Commercial/Self Funded |
$151.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.71
|
| 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 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: Cigna of CA PPO |
$176.48
|
| 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 |
$153.04
|
| Rate for Payer: Cash Price |
$107.32
|
| Rate for Payer: Cigna of CA HMO |
$152.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.94
|
| 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 Foundation Hospitals Commercial/Self Funded |
$151.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.71
|
| 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 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 |
$194.32
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.97
|
| 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 Foundation Hospitals Commercial/Self Funded |
$192.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.66
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.97
|
| 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 Foundation Hospitals Commercial/Self Funded |
$192.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.66
|
| 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 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 |
$1,805.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2,293.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,512.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$938.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,894.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,061.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,759.97
|
| 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
|
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 |
$1,805.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2,293.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,512.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$938.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,894.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,061.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,759.97
|
| 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 |
915355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$596.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$596.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,894.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,759.97
|
| 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 |
$1,938.95
|
| 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 |
905355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$596.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$596.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,894.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,759.97
|
| 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 |
$1,938.95
|
| 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 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 |
$2,567.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,261.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2,150.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,077.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,693.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,349.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,502.19
|
| 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
|
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 |
$2,567.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,261.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2,150.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,077.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,693.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,349.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,502.19
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$848.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,693.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,502.19
|
| 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 |
$2,756.65
|
| 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
|
IP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
905355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$848.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$848.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,693.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,502.19
|
| 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 |
$2,756.65
|
| 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 PSEUDOANEURYSM INJECT TRT
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Adventist Health Commercial |
$249.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$873.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$499.20
|
| Rate for Payer: Galaxy Health WC |
$1,060.80
|
| Rate for Payer: Global Benefits Group Commercial |
$748.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$792.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$736.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.52
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: Networks By Design Commercial |
$811.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,060.80
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$249.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$798.72
|
| Rate for Payer: Cigna of CA PPO |
$923.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$873.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$1,060.80
|
| Rate for Payer: Global Benefits Group Commercial |
$748.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$262.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$792.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$811.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,060.80
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC PSTNR, NEONATAL Z-FLO 10X7
|
Facility
|
OP
|
$135.89
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$115.51 |
| Rate for Payer: Networks By Design Commercial |
$88.33
|
| Rate for Payer: Adventist Health Commercial |
$27.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.20
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: Cigna of CA HMO |
$86.97
|
| Rate for Payer: Cigna of CA PPO |
$100.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$115.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.36
|
| Rate for Payer: EPIC Health Plan Senior |
$54.36
|
| Rate for Payer: Galaxy Health WC |
$115.51
|
| Rate for Payer: Global Benefits Group Commercial |
$81.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.12
|
| Rate for Payer: Multiplan Commercial |
$108.71
|
| Rate for Payer: Prime Health Services Commercial |
$115.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.94
|
| Rate for Payer: United Healthcare All Other HMO |
$67.94
|
| Rate for Payer: United Healthcare HMO Rider |
$67.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.51
|
| Rate for Payer: Vantage Medical Group Senior |
$115.51
|
|
|
HC PSTNR, NEONATAL Z-FLO 10X7
|
Facility
|
IP
|
$135.89
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$115.51 |
| Rate for Payer: Adventist Health Commercial |
$27.18
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.36
|
| Rate for Payer: EPIC Health Plan Senior |
$54.36
|
| Rate for Payer: Galaxy Health WC |
$115.51
|
| Rate for Payer: Global Benefits Group Commercial |
$81.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.61
|
| Rate for Payer: Multiplan Commercial |
$108.71
|
| Rate for Payer: Networks By Design Commercial |
$88.33
|
| Rate for Payer: Prime Health Services Commercial |
$115.51
|
|
|
HC PSTNR, NEONATAL Z-FLO 16X24
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901605556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.19
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC PSTNR, NEONATAL Z-FLO 16X24
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901605556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC PSTNR, ZFLO NEO 12X20 PICK1300
|
Facility
|
OP
|
$497.87
|
|
| Hospital Charge Code |
901605552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$423.19 |
| Rate for Payer: Adventist Health Commercial |
$99.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$326.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$423.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$373.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.48
|
| Rate for Payer: Cash Price |
$224.04
|
| Rate for Payer: Cigna of CA HMO |
$318.64
|
| Rate for Payer: Cigna of CA PPO |
$368.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$423.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$423.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$423.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$348.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$199.15
|
| Rate for Payer: Galaxy Health WC |
$423.19
|
| Rate for Payer: Global Benefits Group Commercial |
$298.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$180.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$293.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$348.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$348.51
|
| Rate for Payer: Multiplan Commercial |
$398.30
|
| Rate for Payer: Networks By Design Commercial |
$323.62
|
| Rate for Payer: Prime Health Services Commercial |
$423.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$298.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$298.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.94
|
| Rate for Payer: United Healthcare All Other HMO |
$248.94
|
| Rate for Payer: United Healthcare HMO Rider |
$248.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$423.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$423.19
|
| Rate for Payer: Vantage Medical Group Senior |
$423.19
|
|
|
HC PSTNR, ZFLO NEO 12X20 PICK1300
|
Facility
|
IP
|
$497.87
|
|
| Hospital Charge Code |
901605552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$423.19 |
| Rate for Payer: Adventist Health Commercial |
$99.57
|
| Rate for Payer: Cash Price |
$224.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$348.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$199.15
|
| Rate for Payer: Galaxy Health WC |
$423.19
|
| Rate for Payer: Global Benefits Group Commercial |
$298.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$293.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.49
|
| Rate for Payer: Multiplan Commercial |
$398.30
|
| Rate for Payer: Networks By Design Commercial |
$323.62
|
| Rate for Payer: Prime Health Services Commercial |
$423.19
|
|
|
HC PSTNR ZFLO NEO CVR STRAPS 20"
|
Facility
|
IP
|
$19.02
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
|
|
HC PSTNR ZFLO NEO CVR STRAPS 20"
|
Facility
|
OP
|
$19.02
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.21
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cigna of CA HMO |
$12.17
|
| Rate for Payer: Cigna of CA PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.17
|
|
