|
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 |
$214.64 |
| Rate for Payer: Adventist Health Commercial |
$47.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.83
|
| 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 Exchange |
$115.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.73
|
| Rate for Payer: Blue Shield of California Commercial |
$151.20
|
| Rate for Payer: Blue Shield of California EPN |
$95.16
|
| Rate for Payer: Cash Price |
$107.32
|
| Rate for Payer: Central Health Plan Commercial |
$190.79
|
| Rate for Payer: Cigna of CA HMO |
$152.63
|
| Rate for Payer: Cigna of CA PPO |
$176.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$202.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$202.72
|
| Rate for Payer: 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 Medi-Cal |
$86.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$166.94
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$95.40
|
| 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 |
$272.54 |
| Rate for Payer: Adventist Health Commercial |
$60.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.90
|
| 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 Exchange |
$146.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.15
|
| Rate for Payer: Blue Shield of California Commercial |
$191.99
|
| Rate for Payer: Blue Shield of California EPN |
$120.83
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Central Health Plan Commercial |
$242.26
|
| 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: Health Management Network EPO/PPO |
$272.54
|
| 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 |
$60.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$211.97
|
| Rate for Payer: Multiplan Commercial |
$227.12
|
| Rate for Payer: Networks By Design Commercial |
$196.83
|
| Rate for Payer: Prime Health Services Commercial |
$257.40
|
| Rate for Payer: Riverside University Health System MISP |
$121.13
|
| 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 |
$272.54 |
| Rate for Payer: Adventist Health Commercial |
$60.56
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Central Health Plan Commercial |
$242.26
|
| 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: Health Management Network EPO/PPO |
$272.54
|
| 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 |
$60.56
|
| Rate for Payer: Multiplan Commercial |
$227.12
|
| 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 |
$960.53 |
| Max. Negotiated Rate |
$2,684.70 |
| 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 |
$1,735.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,392.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,503.43
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,386.40
|
| 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: Health Management Network EPO/PPO |
$2,684.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$960.53
|
| 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 |
$1,223.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,088.10
|
| Rate for Payer: Multiplan Commercial |
$2,237.25
|
| Rate for Payer: Networks By Design Commercial |
$1,491.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,535.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,789.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,789.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,119.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$976.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,535.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,535.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,535.55
|
|
|
HC PRT FT MOLD SKT ANKL HI TOE FL
|
Facility
|
IP
|
$2,983.00
|
|
|
Service Code
|
CPT L5010
|
| Hospital Charge Code |
905355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$596.60 |
| Max. Negotiated Rate |
$2,684.70 |
| Rate for Payer: Adventist Health Commercial |
$596.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,392.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,503.43
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,386.40
|
| 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: Health Management Network EPO/PPO |
$2,684.70
|
| 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 |
$596.60
|
| Rate for Payer: Multiplan Commercial |
$2,237.25
|
| 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
|
OP
|
$2,983.00
|
|
|
Service Code
|
CPT L5010
|
| Hospital Charge Code |
905355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$960.53 |
| Max. Negotiated Rate |
$2,684.70 |
| 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 |
$1,735.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,392.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,503.43
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,386.40
|
| 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: Health Management Network EPO/PPO |
$2,684.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$960.53
|
| 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 |
$1,223.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,088.10
|
| Rate for Payer: Multiplan Commercial |
$2,237.25
|
| Rate for Payer: Networks By Design Commercial |
$1,491.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,535.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,193.20
|
| 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 |
$2,684.70 |
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,386.40
|
| Rate for Payer: Cigna of CA HMO |
$2,088.10
|
| Rate for Payer: Cigna of CA PPO |
$2,088.10
|
| Rate for Payer: Adventist Health Commercial |
$596.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,392.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,503.43
|
| 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: Health Management Network EPO/PPO |
$2,684.70
|
| 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 |
$596.60
|
| Rate for Payer: Multiplan Commercial |
$2,237.25
|
| 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
|
IP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
915355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$848.20 |
| Max. Negotiated Rate |
$3,816.90 |
| Rate for Payer: United Healthcare HMO Rider |
$1,515.73
|
| Rate for Payer: Adventist Health Commercial |
$848.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,401.28
|
| Rate for Payer: Blue Shield of California EPN |
$2,137.46
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,392.80
|
| 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: Health Management Network EPO/PPO |
$3,816.90
|
| 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 |
$848.20
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
| 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 Select/Navigate/Core |
$1,388.93
|
|
|
HC PRT FT MOLD SKT TIB TUBERCLE
|
Facility
|
OP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
915355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,388.93 |
| Max. Negotiated Rate |
$3,816.90 |
| 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 |
$2,466.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3,401.28
|
| Rate for Payer: Blue Shield of California EPN |
$2,137.46
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,392.80
|
| 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: Health Management Network EPO/PPO |
$3,816.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,126.90
|
| 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 |
$1,738.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,968.70
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
| Rate for Payer: Networks By Design Commercial |
$2,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.40
|
| 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 |
$1,388.93 |
| Max. Negotiated Rate |
$3,816.90 |
| 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 |
$2,466.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3,401.28
|
| Rate for Payer: Blue Shield of California EPN |
$2,137.46
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,392.80
|
| 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: Health Management Network EPO/PPO |
$3,816.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,126.90
|
| 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 |
$1,738.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,968.70
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
| Rate for Payer: Networks By Design Commercial |
$2,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,544.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,544.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,591.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,549.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,515.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,388.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,604.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,604.85
|
|
|
HC PRT FT MOLD SKT TIB TUBERCLE
|
Facility
|
IP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
905355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$848.20 |
| Max. Negotiated Rate |
$3,816.90 |
| Rate for Payer: Adventist Health Commercial |
$848.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,401.28
|
| Rate for Payer: Blue Shield of California EPN |
$2,137.46
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,392.80
|
| 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: Health Management Network EPO/PPO |
$3,816.90
|
| 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 |
$848.20
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
| 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
|
$1,031.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.20 |
| Max. Negotiated Rate |
$927.90 |
| Rate for Payer: Adventist Health Commercial |
$206.20
|
| Rate for Payer: Cash Price |
$463.95
|
| Rate for Payer: Central Health Plan Commercial |
$824.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$721.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.40
|
| Rate for Payer: EPIC Health Plan Senior |
$412.40
|
| Rate for Payer: Galaxy Health WC |
$876.35
|
| Rate for Payer: Global Benefits Group Commercial |
$618.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$654.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$608.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.20
|
| Rate for Payer: Multiplan Commercial |
$773.25
|
| Rate for Payer: Networks By Design Commercial |
$670.15
|
| Rate for Payer: Prime Health Services Commercial |
$876.35
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$206.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 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 |
$1,251.66
|
| 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 |
$463.95
|
| Rate for Payer: Cash Price |
$463.95
|
| Rate for Payer: Cash Price |
$463.95
|
| Rate for Payer: Central Health Plan Commercial |
$824.80
|
| Rate for Payer: Cigna of CA HMO |
$659.84
|
| Rate for Payer: Cigna of CA PPO |
$762.94
|
| 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 |
$721.70
|
| 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 |
$876.35
|
| Rate for Payer: Global Benefits Group Commercial |
$618.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$268.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$654.68
|
| 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 |
$206.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$773.25
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$670.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$876.35
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.50
|
| 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
|
IP
|
$135.58
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$122.02 |
| Rate for Payer: Adventist Health Commercial |
$27.12
|
| Rate for Payer: Cash Price |
$61.01
|
| Rate for Payer: Central Health Plan Commercial |
$108.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.23
|
| Rate for Payer: EPIC Health Plan Senior |
$54.23
|
| Rate for Payer: Galaxy Health WC |
$115.24
|
| Rate for Payer: Global Benefits Group Commercial |
$81.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$101.69
|
| Rate for Payer: Networks By Design Commercial |
$88.13
|
| Rate for Payer: Prime Health Services Commercial |
$115.24
|
|
|
HC PSTNR, NEONATAL Z-FLO 10X7
|
Facility
|
OP
|
$135.58
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$122.02 |
| Rate for Payer: Adventist Health Commercial |
$27.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.87
|
| Rate for Payer: Blue Shield of California Commercial |
$85.96
|
| Rate for Payer: Blue Shield of California EPN |
$54.10
|
| Rate for Payer: Cash Price |
$61.01
|
| Rate for Payer: Central Health Plan Commercial |
$108.46
|
| Rate for Payer: Cigna of CA HMO |
$86.77
|
| Rate for Payer: Cigna of CA PPO |
$100.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$115.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.23
|
| Rate for Payer: EPIC Health Plan Senior |
$54.23
|
| Rate for Payer: Galaxy Health WC |
$115.24
|
| Rate for Payer: Global Benefits Group Commercial |
$81.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.91
|
| Rate for Payer: Multiplan Commercial |
$101.69
|
| Rate for Payer: Networks By Design Commercial |
$88.13
|
| Rate for Payer: Prime Health Services Commercial |
$115.24
|
| Rate for Payer: Riverside University Health System MISP |
$54.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.79
|
| Rate for Payer: United Healthcare All Other HMO |
$67.79
|
| Rate for Payer: United Healthcare HMO Rider |
$67.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.24
|
| Rate for Payer: Vantage Medical Group Senior |
$115.24
|
|
|
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 |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| 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 Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| 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: Health Management Network EPO/PPO |
$522.00
|
| 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 |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| 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 |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| 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: Health Management Network EPO/PPO |
$522.00
|
| 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 |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| 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
|
IP
|
$497.87
|
|
| Hospital Charge Code |
901605552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$448.08 |
| Rate for Payer: Adventist Health Commercial |
$99.57
|
| Rate for Payer: Cash Price |
$224.04
|
| Rate for Payer: Central Health Plan Commercial |
$398.30
|
| 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: Health Management Network EPO/PPO |
$448.08
|
| 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 |
$99.57
|
| Rate for Payer: Multiplan Commercial |
$373.40
|
| Rate for Payer: Networks By Design Commercial |
$323.62
|
| Rate for Payer: Prime Health Services Commercial |
$423.19
|
|
|
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 |
$448.08 |
| Rate for Payer: Adventist Health Commercial |
$99.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$302.36
|
| 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 Exchange |
$241.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.61
|
| Rate for Payer: Blue Shield of California Commercial |
$315.65
|
| Rate for Payer: Blue Shield of California EPN |
$198.65
|
| Rate for Payer: Cash Price |
$224.04
|
| Rate for Payer: Central Health Plan Commercial |
$398.30
|
| 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: Health Management Network EPO/PPO |
$448.08
|
| 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 |
$99.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.51
|
| Rate for Payer: Multiplan Commercial |
$373.40
|
| Rate for Payer: Networks By Design Commercial |
$323.62
|
| Rate for Payer: Prime Health Services Commercial |
$423.19
|
| Rate for Payer: Riverside University Health System MISP |
$199.15
|
| 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 CVR STRAPS 20"
|
Facility
|
OP
|
$19.02
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.55
|
| 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 Exchange |
$9.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$12.06
|
| Rate for Payer: Blue Shield of California EPN |
$7.59
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| 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: Health Management Network EPO/PPO |
$17.12
|
| 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 |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
| Rate for Payer: Riverside University Health System MISP |
$7.61
|
| 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
|
|
|
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 |
$17.12 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| 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: Health Management Network EPO/PPO |
$17.12
|
| 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 |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
IP
|
$376.59
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$338.93 |
| Rate for Payer: Adventist Health Commercial |
$75.32
|
| Rate for Payer: Cash Price |
$169.47
|
| Rate for Payer: Central Health Plan Commercial |
$301.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.64
|
| Rate for Payer: EPIC Health Plan Senior |
$150.64
|
| Rate for Payer: Galaxy Health WC |
$320.10
|
| Rate for Payer: Global Benefits Group Commercial |
$225.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$338.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.32
|
| Rate for Payer: Multiplan Commercial |
$282.44
|
| Rate for Payer: Networks By Design Commercial |
$244.78
|
| Rate for Payer: Prime Health Services Commercial |
$320.10
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
OP
|
$376.59
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$338.93 |
| Rate for Payer: Adventist Health Commercial |
$75.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.06
|
| Rate for Payer: Blue Shield of California Commercial |
$238.76
|
| Rate for Payer: Blue Shield of California EPN |
$150.26
|
| Rate for Payer: Cash Price |
$169.47
|
| Rate for Payer: Central Health Plan Commercial |
$301.27
|
| Rate for Payer: Cigna of CA HMO |
$241.02
|
| Rate for Payer: Cigna of CA PPO |
$278.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.64
|
| Rate for Payer: EPIC Health Plan Senior |
$150.64
|
| Rate for Payer: Galaxy Health WC |
$320.10
|
| Rate for Payer: Global Benefits Group Commercial |
$225.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$338.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$263.61
|
| Rate for Payer: Multiplan Commercial |
$282.44
|
| Rate for Payer: Networks By Design Commercial |
$244.78
|
| Rate for Payer: Prime Health Services Commercial |
$320.10
|
| Rate for Payer: Riverside University Health System MISP |
$150.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.29
|
| Rate for Payer: United Healthcare All Other HMO |
$188.29
|
| Rate for Payer: United Healthcare HMO Rider |
$188.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.10
|
| Rate for Payer: Vantage Medical Group Senior |
$320.10
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
IP
|
$227.15
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$204.44 |
| Rate for Payer: Adventist Health Commercial |
$45.43
|
| Rate for Payer: Cash Price |
$102.22
|
| Rate for Payer: Central Health Plan Commercial |
$181.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.86
|
| Rate for Payer: EPIC Health Plan Senior |
$90.86
|
| Rate for Payer: Galaxy Health WC |
$193.08
|
| Rate for Payer: Global Benefits Group Commercial |
$136.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.43
|
| Rate for Payer: Multiplan Commercial |
$170.36
|
| Rate for Payer: Networks By Design Commercial |
$147.65
|
| Rate for Payer: Prime Health Services Commercial |
$193.08
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
OP
|
$227.15
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$204.44 |
| Rate for Payer: Adventist Health Commercial |
$45.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.13
|
| Rate for Payer: Blue Shield of California Commercial |
$144.01
|
| Rate for Payer: Blue Shield of California EPN |
$90.63
|
| Rate for Payer: Cash Price |
$102.22
|
| Rate for Payer: Central Health Plan Commercial |
$181.72
|
| Rate for Payer: Cigna of CA HMO |
$145.38
|
| Rate for Payer: Cigna of CA PPO |
$168.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.86
|
| Rate for Payer: EPIC Health Plan Senior |
$90.86
|
| Rate for Payer: Galaxy Health WC |
$193.08
|
| Rate for Payer: Global Benefits Group Commercial |
$136.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$170.36
|
| Rate for Payer: Networks By Design Commercial |
$147.65
|
| Rate for Payer: Prime Health Services Commercial |
$193.08
|
| Rate for Payer: Riverside University Health System MISP |
$90.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.58
|
| Rate for Payer: United Healthcare All Other HMO |
$113.58
|
| Rate for Payer: United Healthcare HMO Rider |
$113.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$193.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.08
|
| Rate for Payer: Vantage Medical Group Senior |
$193.08
|
|
