|
HC EV FEM POP ARTERIAL REVASC
|
Facility
|
OP
|
$30,560.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$18,336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$13,752.00
|
| Rate for Payer: Cash Price |
$13,752.00
|
| Rate for Payer: Cigna of CA PPO |
$22,614.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$25,976.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22,920.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,643.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,334.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$24,448.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$19,864.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.00
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC EV FEM POP ARTERIAL REVASC
|
Facility
|
IP
|
$30,560.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,334.40 |
| Max. Negotiated Rate |
$25,976.00 |
| Rate for Payer: Cash Price |
$13,752.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,224.00
|
| Rate for Payer: Galaxy Health WC |
$25,976.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,643.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,334.40
|
| Rate for Payer: Multiplan Commercial |
$24,448.00
|
| Rate for Payer: Networks By Design Commercial |
$19,864.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.00
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
OP
|
$49,545.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$59,142.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,093.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,668.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,062.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$29,727.00
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$22,295.25
|
| Rate for Payer: Cash Price |
$22,295.25
|
| Rate for Payer: Cigna of CA PPO |
$36,663.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,093.76
|
| Rate for Payer: Dignity Health Media |
$36,062.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,668.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,684.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,062.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$36,062.51
|
| Rate for Payer: Galaxy Health WC |
$42,113.25
|
| Rate for Payer: Global Benefits Group Commercial |
$29,727.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37,158.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$59,142.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$59,142.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58,421.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$58,421.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,062.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,876.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,062.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,890.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,438.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,323.76
|
| Rate for Payer: Multiplan Commercial |
$39,636.00
|
| Rate for Payer: Multiplan WC |
$31,747.68
|
| Rate for Payer: Networks By Design Commercial |
$32,204.25
|
| Rate for Payer: Prime Health Services Commercial |
$42,113.25
|
| Rate for Payer: Prime Health Services WC |
$31,423.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,727.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54,093.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,668.76
|
| Rate for Payer: Vantage Medical Group Senior |
$36,062.51
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
IP
|
$49,545.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,890.80 |
| Max. Negotiated Rate |
$42,113.25 |
| Rate for Payer: Cash Price |
$22,295.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,818.00
|
| Rate for Payer: Galaxy Health WC |
$42,113.25
|
| Rate for Payer: Global Benefits Group Commercial |
$29,727.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,876.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,890.80
|
| Rate for Payer: Multiplan Commercial |
$39,636.00
|
| Rate for Payer: Networks By Design Commercial |
$32,204.25
|
| Rate for Payer: Prime Health Services Commercial |
$42,113.25
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$3,183.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.52 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,909.80
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cigna of CA PPO |
$2,355.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,705.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,909.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,387.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,546.40
|
| Rate for Payer: Networks By Design Commercial |
$2,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,705.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,909.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,591.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,591.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,591.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,591.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
IP
|
$3,183.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$763.92 |
| Max. Negotiated Rate |
$2,705.55 |
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,273.20
|
| Rate for Payer: Galaxy Health WC |
$2,705.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,909.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,212.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.92
|
| Rate for Payer: Multiplan Commercial |
$2,546.40
|
| Rate for Payer: Networks By Design Commercial |
$2,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,705.55
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.47 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,425.80
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA PPO |
$2,991.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,032.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,021.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,021.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,021.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$970.32 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
IP
|
$4,130.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$991.20 |
| Max. Negotiated Rate |
$3,510.50 |
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,652.00
|
| Rate for Payer: Galaxy Health WC |
$3,510.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,478.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,754.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.20
|
| Rate for Payer: Multiplan Commercial |
$3,304.00
|
| Rate for Payer: Networks By Design Commercial |
$2,684.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,510.50
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
OP
|
$4,130.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,478.00
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cigna of CA PPO |
$3,056.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,510.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,478.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,097.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,754.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,304.00
|
| Rate for Payer: Networks By Design Commercial |
$2,684.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,510.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,478.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,065.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,065.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,065.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,065.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC EXC BEN LES-HD/HND/FT 3.1-4.CM
|
Facility
|
IP
|
$6,653.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
900501737
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,596.72 |
| Max. Negotiated Rate |
$5,655.05 |
| Rate for Payer: Cash Price |
$2,993.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,661.20
|
| Rate for Payer: Galaxy Health WC |
$5,655.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,991.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,437.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,534.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,596.72
|
| Rate for Payer: Multiplan Commercial |
$5,322.40
|
| Rate for Payer: Networks By Design Commercial |
$4,324.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,655.05
|
|
|
HC EXC BEN LES-HD/HND/FT 3.1-4.CM
|
Facility
|
OP
|
$6,653.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
900501737
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,991.80
|
| Rate for Payer: Cash Price |
$2,993.85
|
| Rate for Payer: Cash Price |
$2,993.85
|
| Rate for Payer: Cash Price |
$2,993.85
|
| Rate for Payer: Cigna of CA PPO |
$4,923.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$5,655.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,991.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,989.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,437.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,596.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$5,322.40
|
| Rate for Payer: Networks By Design Commercial |
$4,324.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,655.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,991.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,326.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,326.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,326.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,326.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
OP
|
$2,662.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.45 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,597.20
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cigna of CA PPO |
$1,969.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,996.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$2,129.60
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,597.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,331.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,331.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,331.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
IP
|
$2,662.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$638.88 |
| Max. Negotiated Rate |
$2,262.70 |
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.88
|
| Rate for Payer: Multiplan Commercial |
$2,129.60
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$580.80 |
| Max. Negotiated Rate |
$2,057.00 |
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.00
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Multiplan Commercial |
$1,936.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cigna of CA PPO |
$1,790.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,815.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,936.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,210.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
OP
|
$2,662.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$307.57 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,597.20
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cigna of CA PPO |
$1,969.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,996.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,129.60
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,597.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,331.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,331.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,331.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
IP
|
$2,662.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$638.88 |
| Max. Negotiated Rate |
$2,262.70 |
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.88
|
| Rate for Payer: Multiplan Commercial |
$2,129.60
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
|
|
HC EXCHG BLD TRANS NEWBORN
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 36450
|
| Hospital Charge Code |
906812206
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC EXCHG BLD TRANS NEWBORN
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 36450
|
| Hospital Charge Code |
906812206
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$756.00
|
| Rate for Payer: Blue Shield of California Commercial |
$928.62
|
| Rate for Payer: Blue Shield of California EPN |
$735.84
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$945.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$878.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$878.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC EXCHG BLD TRANS OTHER THAN NEWBORN
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
906812205
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$756.00
|
| Rate for Payer: Blue Shield of California Commercial |
$928.62
|
| Rate for Payer: Blue Shield of California EPN |
$735.84
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$945.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$878.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$878.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC EXCHG BLD TRANS OTHER THAN NEWBORN
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
906812205
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
OP
|
$7,675.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$6,597.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,605.00
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Cigna of CA PPO |
$5,679.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,523.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,756.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,842.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$6,140.00
|
| Rate for Payer: Networks By Design Commercial |
$4,988.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,523.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,605.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,837.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,837.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,837.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$7,675.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,842.00 |
| Max. Negotiated Rate |
$6,523.75 |
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,070.00
|
| Rate for Payer: Galaxy Health WC |
$6,523.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,924.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,842.00
|
| Rate for Payer: Multiplan Commercial |
$6,140.00
|
| Rate for Payer: Networks By Design Commercial |
$4,988.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,523.75
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
OP
|
$2,767.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$664.08 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,660.20
|
| Rate for Payer: Cash Price |
$1,245.15
|
| Rate for Payer: Cash Price |
$1,245.15
|
| Rate for Payer: Cash Price |
$1,245.15
|
| Rate for Payer: Cigna of CA PPO |
$2,047.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$2,351.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,660.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,075.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,845.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,054.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$2,213.60
|
| Rate for Payer: Networks By Design Commercial |
$1,798.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,351.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,660.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,383.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,383.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,383.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,383.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
