|
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 |
$735.00 |
| Max. Negotiated Rate |
$101,753.00 |
| Rate for Payer: Adventist Health Commercial |
$1,736.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,519.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$735.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,965.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,808.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5,271.19
|
| 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 |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$735.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$735.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,102.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,792.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| 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 |
$735.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,381.40
|
| Rate for Payer: Prime Health Services Medicare |
$779.10
|
| Rate for Payer: Riverside University Health System MISP |
$808.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$72,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68,115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63,320.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$25,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$735.00
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
IP
|
$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: 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 Permanente of CA Commercial/Self Funded |
$5,792.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,308.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,375.40
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,131.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,050.44
|
| 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 PROVOCHOLINE CHALLENGE
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$295.00 |
| Max. Negotiated Rate |
$1,527.30 |
| Rate for Payer: Adventist Health Commercial |
$339.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,030.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$380.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,030.08
|
| 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 |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| 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 |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| 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 |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| 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 |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC 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 |
$422.27
|
| Rate for Payer: Blue Shield of California Commercial |
$555.79
|
| 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: 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: InnovAge PACE Commercial |
$359.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$479.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$503.30
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$555.79
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$479.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.06
|
| 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 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$809.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| 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 |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| 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 |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$550.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,698.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| 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 |
$1,131.20
|
| 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 |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,427.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,698.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,541.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,504.47
|
| 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
|
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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,617.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,281.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,838.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,769.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,572.13
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| 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: 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: 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: InnovAge PACE Commercial |
$3,892.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,192.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,966.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,818.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,449.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,449.50
|
| Rate for Payer: Multiplan Commercial |
$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 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: 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 Permanente of CA Commercial/Self Funded |
$5,192.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,966.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,818.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.00
|
| 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 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 |
$14,013.00 |
| Rate for Payer: Adventist Health Commercial |
$3,114.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,538.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,144.26
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| 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: 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 |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$13,234.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,013.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,385.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,932.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| 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 |
$7,244.35
|
| Rate for Payer: Prime Health Services Commercial |
$13,234.50
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$10,385.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,932.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,637.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,114.00
|
| 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 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 |
$140.07
|
| Rate for Payer: Blue Shield of California Commercial |
$145.72
|
| 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: 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: InnovAge PACE Commercial |
$119.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.94
|
| Rate for Payer: Multiplan Commercial |
$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 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: 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 Permanente of CA Commercial/Self Funded |
$159.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
|
|
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 |
$177.85
|
| Rate for Payer: Blue Shield of California Commercial |
$185.02
|
| 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: 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: InnovAge PACE Commercial |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$211.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$211.97
|
| Rate for Payer: Multiplan Commercial |
$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: 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 Permanente of CA Commercial/Self Funded |
$201.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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: Adventist Health Commercial |
$596.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,305.86
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,846.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
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 |
$1,751.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,305.86
|
| 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: 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: InnovAge PACE Commercial |
$1,491.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,846.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,223.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,088.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,088.10
|
| Rate for Payer: Multiplan Commercial |
$2,237.25
|
| 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 |
$2,305.86
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,846.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$1,751.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,305.86
|
| 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: 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: InnovAge PACE Commercial |
$1,491.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,846.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,223.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,088.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,088.10
|
| Rate for Payer: Multiplan Commercial |
$2,237.25
|
| 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 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 |
$2,490.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3,278.29
|
| 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: 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: InnovAge PACE Commercial |
$2,120.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,349.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,968.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,968.70
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
| 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 |
$3,278.29
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,615.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 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: Adventist Health Commercial |
$848.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,278.29
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,615.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 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 |
$2,490.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3,278.29
|
| 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: 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: InnovAge PACE Commercial |
$2,120.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,349.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,968.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,968.70
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$687.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.19
|
| 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
|
|
