|
HC PROTON INTERMEDIATE
|
Facility
|
OP
|
$16,490.00
|
|
|
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 |
$3,298.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,607.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,208.00
|
| 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 Exchange |
$7,529.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,043.12
|
| Rate for Payer: Blue Shield of California Commercial |
$10,388.70
|
| Rate for Payer: Blue Shield of California EPN |
$6,546.53
|
| Rate for Payer: Cash Price |
$7,420.50
|
| Rate for Payer: Cash Price |
$7,420.50
|
| Rate for Payer: Cash Price |
$7,420.50
|
| Rate for Payer: Central Health Plan Commercial |
$13,192.00
|
| Rate for Payer: Cigna of CA HMO |
$9,894.00
|
| Rate for Payer: Cigna of CA PPO |
$9,894.00
|
| 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 |
$11,543.00
|
| 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 |
$14,016.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,894.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,841.00
|
| 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 |
$10,471.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,250.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,298.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,153.89
|
| Rate for Payer: Multiplan Commercial |
$12,367.50
|
| Rate for Payer: Networks By Design Commercial |
$9,894.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,607.38
|
| Rate for Payer: Prime Health Services Commercial |
$14,016.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,703.82
|
| Rate for Payer: Riverside University Health System MISP |
$1,768.12
|
| 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 INTERMEDIATE
|
Facility
|
IP
|
$16,490.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$3,298.00 |
| Max. Negotiated Rate |
$14,841.00 |
| Rate for Payer: Adventist Health Commercial |
$3,298.00
|
| Rate for Payer: Cash Price |
$7,420.50
|
| Rate for Payer: Central Health Plan Commercial |
$13,192.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,543.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,596.00
|
| Rate for Payer: Galaxy Health WC |
$14,016.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,894.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,841.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,471.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,729.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,298.00
|
| Rate for Payer: Multiplan Commercial |
$12,367.50
|
| Rate for Payer: Networks By Design Commercial |
$10,718.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,016.50
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
IP
|
$12,603.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$11,342.70 |
| Rate for Payer: Adventist Health Commercial |
$2,520.60
|
| Rate for Payer: Cash Price |
$5,671.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,082.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,822.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,041.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,041.20
|
| Rate for Payer: Galaxy Health WC |
$10,712.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,561.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,342.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,002.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,435.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,520.60
|
| Rate for Payer: Multiplan Commercial |
$9,452.25
|
| Rate for Payer: Networks By Design Commercial |
$8,191.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,712.55
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
OP
|
$12,603.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,519.00 |
| Max. Negotiated Rate |
$101,753.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,607.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,519.00
|
| 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 Exchange |
$5,754.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,911.49
|
| Rate for Payer: Blue Shield of California Commercial |
$7,939.89
|
| Rate for Payer: Blue Shield of California EPN |
$5,003.39
|
| Rate for Payer: Cash Price |
$5,671.35
|
| Rate for Payer: Cash Price |
$5,671.35
|
| Rate for Payer: Cash Price |
$5,671.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,082.40
|
| Rate for Payer: Cigna of CA HMO |
$7,561.80
|
| Rate for Payer: Cigna of CA PPO |
$7,561.80
|
| 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 |
$8,822.10
|
| 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 |
$10,712.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,561.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,342.70
|
| 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 |
$8,002.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,250.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,520.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,153.89
|
| Rate for Payer: Multiplan Commercial |
$9,452.25
|
| Rate for Payer: Networks By Design Commercial |
$7,561.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,607.38
|
| Rate for Payer: Prime Health Services Commercial |
$10,712.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,703.82
|
| Rate for Payer: Riverside University Health System MISP |
$1,768.12
|
| 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 WO COMPENSATOR
|
Facility
|
OP
|
$8,684.00
|
|
|
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 |
$1,736.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$710.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,519.00
|
| 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 Exchange |
$3,965.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,762.31
|
| Rate for Payer: Blue Shield of California Commercial |
$5,470.92
|
| Rate for Payer: Blue Shield of California EPN |
$3,447.55
|
| Rate for Payer: Cash Price |
$3,907.80
|
| Rate for Payer: Cash Price |
$3,907.80
|
| Rate for Payer: Cash Price |
$3,907.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,947.20
|
| Rate for Payer: Cigna of CA HMO |
$5,210.40
|
| Rate for Payer: Cigna of CA PPO |
$5,210.40
|
| 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 |
$6,078.80
|
| 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 |
$7,381.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,210.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,815.60
|
| 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 |
$5,514.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$952.28
|
| Rate for Payer: Multiplan Commercial |
$6,513.00
|
| Rate for Payer: Networks By Design Commercial |
$5,210.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$710.66
|
| Rate for Payer: Prime Health Services Commercial |
$7,381.40
|
| Rate for Payer: Prime Health Services Medicare |
$753.30
|
| Rate for Payer: Riverside University Health System MISP |
$781.73
|
| 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 PROTON SIMPLE WO COMPENSATOR
|
Facility
|
IP
|
$8,684.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,736.80 |
| Max. Negotiated Rate |
$7,815.60 |
| Rate for Payer: Adventist Health Commercial |
$1,736.80
|
| Rate for Payer: Cash Price |
$3,907.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,947.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,078.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,473.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,473.60
|
| Rate for Payer: Galaxy Health WC |
$7,381.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,210.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,815.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,514.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,123.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.80
|
| Rate for Payer: Multiplan Commercial |
$6,513.00
|
| Rate for Payer: Networks By Design Commercial |
$5,644.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,381.40
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$202.66 |
| Max. Negotiated Rate |
$1,527.30 |
| Rate for Payer: Adventist Health Commercial |
$339.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.66
|
| 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 Exchange |
$380.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$987.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,069.11
|
| Rate for Payer: Blue Shield of California EPN |
$673.71
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,086.08
|
| Rate for Payer: Cigna of CA PPO |
$1,255.78
|
| 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 |
$1,187.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,018.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,527.30
|
| 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 |
$1,077.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$616.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$1,272.75
|
| Rate for Payer: Networks By Design Commercial |
$1,103.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,018.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,018.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PROVOCHOLINE CHALLENGE
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$339.40 |
| Max. Negotiated Rate |
$1,527.30 |
| Rate for Payer: Adventist Health Commercial |
$339.40
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,357.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,187.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.80
|
| Rate for Payer: EPIC Health Plan Senior |
$678.80
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,018.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,527.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,077.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,001.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.40
|
| Rate for Payer: Multiplan Commercial |
$1,272.75
|
| Rate for Payer: Networks By Design Commercial |
$1,103.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
|
|
HC PROVOX LARYNGECTOMY TUBE 12/55
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.80 |
| Max. Negotiated Rate |
$647.10 |
| Rate for Payer: Adventist Health Commercial |
$143.80
|
| Rate for Payer: Blue Shield of California Commercial |
$576.64
|
| Rate for Payer: Blue Shield of California EPN |
$362.38
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Central Health Plan Commercial |
$575.20
|
| Rate for Payer: Cigna of CA HMO |
$503.30
|
| Rate for Payer: Cigna of CA PPO |
$503.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$503.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$287.60
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$647.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$456.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.80
|
| Rate for Payer: Multiplan Commercial |
$539.25
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.84
|
| Rate for Payer: United Healthcare All Other HMO |
$262.65
|
| Rate for Payer: United Healthcare HMO Rider |
$256.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.47
|
|
|
HC PROVOX LARYNGECTOMY TUBE 12/55
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$235.47 |
| Max. Negotiated Rate |
$647.10 |
| Rate for Payer: Adventist Health Commercial |
$294.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$611.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$539.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.24
|
| Rate for Payer: Blue Shield of California Commercial |
$576.64
|
| Rate for Payer: Blue Shield of California EPN |
$362.38
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Central Health Plan Commercial |
$575.20
|
| Rate for Payer: Cigna of CA HMO |
$503.30
|
| Rate for Payer: Cigna of CA PPO |
$503.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$611.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$611.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$503.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$287.60
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$647.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$456.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$503.30
|
| Rate for Payer: Multiplan Commercial |
$539.25
|
| Rate for Payer: Networks By Design Commercial |
$359.50
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
| Rate for Payer: Riverside University Health System MISP |
$287.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$431.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$431.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.84
|
| Rate for Payer: United Healthcare All Other HMO |
$262.65
|
| Rate for Payer: United Healthcare HMO Rider |
$256.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$611.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.15
|
| Rate for Payer: Vantage Medical Group Senior |
$611.15
|
|
|
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 |
$611.10 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Central Health Plan Commercial |
$543.20
|
| 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: Health Management Network EPO/PPO |
$611.10
|
| 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 |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
|
|
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 |
$119.46 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$328.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.97
|
| Rate for Payer: Blue Shield of California Commercial |
$430.49
|
| Rate for Payer: Blue Shield of California EPN |
$270.92
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Central Health Plan Commercial |
$543.20
|
| 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: Health Management Network EPO/PPO |
$611.10
|
| 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 |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$475.30
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
| Rate for Payer: Riverside University Health System MISP |
$271.60
|
| 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 LARYTUBE 12/36 STANDARD
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900831800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$328.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.97
|
| Rate for Payer: Blue Shield of California Commercial |
$430.49
|
| Rate for Payer: Blue Shield of California EPN |
$270.92
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Central Health Plan Commercial |
$543.20
|
| 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: Health Management Network EPO/PPO |
$611.10
|
| 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 |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$475.30
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
| Rate for Payer: Riverside University Health System MISP |
$271.60
|
| 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 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 |
$611.10 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Central Health Plan Commercial |
$543.20
|
| 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: Health Management Network EPO/PPO |
$611.10
|
| 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 |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| 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 |
$119.46 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$328.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.97
|
| Rate for Payer: Blue Shield of California Commercial |
$430.49
|
| Rate for Payer: Blue Shield of California EPN |
$270.92
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Central Health Plan Commercial |
$543.20
|
| 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: Health Management Network EPO/PPO |
$611.10
|
| 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 |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$475.30
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
| Rate for Payer: Riverside University Health System MISP |
$271.60
|
| 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 |
$611.10 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Central Health Plan Commercial |
$543.20
|
| 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: Health Management Network EPO/PPO |
$611.10
|
| 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 |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$611.10 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Central Health Plan Commercial |
$543.20
|
| 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: Health Management Network EPO/PPO |
$611.10
|
| 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 |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$119.46 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$328.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.97
|
| Rate for Payer: Blue Shield of California Commercial |
$430.49
|
| Rate for Payer: Blue Shield of California EPN |
$270.92
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Central Health Plan Commercial |
$543.20
|
| 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: Health Management Network EPO/PPO |
$611.10
|
| 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 |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$475.30
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: Networks By Design Commercial |
$441.35
|
| Rate for Payer: Prime Health Services Commercial |
$577.15
|
| Rate for Payer: Riverside University Health System MISP |
$271.60
|
| 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 PRQ ASP SPL CRD CYST OR SYRINX
|
Facility
|
OP
|
$4,046.00
|
|
|
Service Code
|
CPT 62268
|
| Hospital Charge Code |
909082268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$550.71 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$809.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,820.70
|
| Rate for Payer: Cash Price |
$1,820.70
|
| Rate for Payer: Cash Price |
$1,820.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,236.80
|
| Rate for Payer: Cigna of CA HMO |
$2,589.44
|
| Rate for Payer: Cigna of CA PPO |
$2,994.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,832.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$3,439.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,427.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,641.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$550.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,569.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$608.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$3,034.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,629.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,439.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,427.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,023.00
|
| 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 |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC PRQ ASP SPL CRD CYST OR SYRINX
|
Facility
|
IP
|
$4,046.00
|
|
|
Service Code
|
CPT 62268
|
| Hospital Charge Code |
909082268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.20 |
| Max. Negotiated Rate |
$3,641.40 |
| Rate for Payer: Adventist Health Commercial |
$809.20
|
| Rate for Payer: Cash Price |
$1,820.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,236.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,832.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,618.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,618.40
|
| Rate for Payer: Galaxy Health WC |
$3,439.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,427.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,641.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,569.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,387.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.20
|
| Rate for Payer: Multiplan Commercial |
$3,034.50
|
| Rate for Payer: Networks By Design Commercial |
$2,629.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,439.10
|
|
|
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 |
$7,006.50 |
| Rate for Payer: Adventist Health Commercial |
$1,557.00
|
| Rate for Payer: Cash Price |
$3,503.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,228.00
|
| 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: Health Management Network EPO/PPO |
$7,006.50
|
| 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 |
$1,557.00
|
| Rate for Payer: Multiplan Commercial |
$5,838.75
|
| 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 SEP TRGT LESION
|
Facility
|
OP
|
$7,785.00
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
906811502
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$7,006.50 |
| Rate for Payer: Adventist Health Commercial |
$1,557.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,727.83
|
| 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 Exchange |
$3,769.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,528.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| 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: Central Health Plan Commercial |
$6,228.00
|
| 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: Health Management Network EPO/PPO |
$7,006.50
|
| 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 |
$1,557.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,449.50
|
| Rate for Payer: Multiplan Commercial |
$5,838.75
|
| Rate for Payer: Networks By Design Commercial |
$5,060.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,617.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,114.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,671.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,671.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,617.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,617.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,617.25
|
|
|
HC PRQ TCAT THER RX NTRAC BLLN 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 |
$14,013.00 |
| Rate for Payer: Adventist Health Commercial |
$3,114.00
|
| Rate for Payer: Cash Price |
$7,006.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,456.00
|
| 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: Health Management Network EPO/PPO |
$14,013.00
|
| 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 |
$3,114.00
|
| Rate for Payer: Multiplan Commercial |
$11,677.50
|
| 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 |
$639.21 |
| Max. Negotiated Rate |
$24,498.80 |
| Rate for Payer: Adventist Health Commercial |
$3,114.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,455.66
|
| 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 Exchange |
$7,538.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,057.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| 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: Central Health Plan Commercial |
$12,456.00
|
| 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: Health Management Network EPO/PPO |
$14,013.00
|
| 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 |
$3,114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$11,677.50
|
| Rate for Payer: Networks By Design Commercial |
$10,120.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Commercial |
$13,234.50
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| 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 |
$214.64 |
| Rate for Payer: Adventist Health Commercial |
$47.70
|
| Rate for Payer: Cash Price |
$107.32
|
| Rate for Payer: Central Health Plan Commercial |
$190.79
|
| 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: Health Management Network EPO/PPO |
$214.64
|
| 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 |
$47.70
|
| Rate for Payer: Multiplan Commercial |
$178.87
|
| Rate for Payer: Networks By Design Commercial |
$155.02
|
| Rate for Payer: Prime Health Services Commercial |
$202.72
|
|
