|
HC ICE INTRACARDIAC ECHO
|
Facility
|
IP
|
$8,187.00
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
906812082
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,964.88 |
| Max. Negotiated Rate |
$6,958.95 |
| Rate for Payer: Cash Price |
$3,684.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,274.80
|
| Rate for Payer: Galaxy Health WC |
$6,958.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,912.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,460.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,119.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,964.88
|
| Rate for Payer: Multiplan Commercial |
$6,549.60
|
| Rate for Payer: Networks By Design Commercial |
$5,321.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,958.95
|
|
|
HC I & D ABSCESS COMPL OR MULT
|
Facility
|
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
900501001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$482.16 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC I & D ABSCESS COMPL OR MULT
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
900501001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.94 |
| 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 |
$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 |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,205.40
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| 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 |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,506.75
|
| 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 |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| 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 |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,004.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,004.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,004.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,004.50
|
| 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 I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$424.56 |
| Max. Negotiated Rate |
$1,503.65 |
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.60
|
| Rate for Payer: Galaxy Health WC |
$1,503.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,061.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,179.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$673.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.56
|
| Rate for Payer: Multiplan Commercial |
$1,415.20
|
| Rate for Payer: Networks By Design Commercial |
$1,149.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,503.65
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.20 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,061.40
|
| 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 |
$796.05
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cigna of CA PPO |
$1,309.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,503.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,061.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,326.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,179.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,415.20
|
| Rate for Payer: Networks By Design Commercial |
$1,149.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,503.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,061.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$424.56 |
| Max. Negotiated Rate |
$1,503.65 |
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.60
|
| Rate for Payer: Galaxy Health WC |
$1,503.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,061.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,179.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$673.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.56
|
| Rate for Payer: Multiplan Commercial |
$1,415.20
|
| Rate for Payer: Networks By Design Commercial |
$1,149.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,503.65
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$207.20 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,061.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,303.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,033.10
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cigna of CA HMO |
$1,132.16
|
| Rate for Payer: Cigna of CA PPO |
$1,309.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,503.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,061.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,326.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,179.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,415.20
|
| Rate for Payer: Networks By Design Commercial |
$1,149.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,503.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,061.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,061.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.56 |
| Max. Negotiated Rate |
$1,503.65 |
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.60
|
| Rate for Payer: Galaxy Health WC |
$1,503.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,061.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,179.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$673.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.56
|
| Rate for Payer: Multiplan Commercial |
$1,415.20
|
| Rate for Payer: Networks By Design Commercial |
$1,149.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,503.65
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.20 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,061.40
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cigna of CA PPO |
$1,309.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,503.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,061.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,326.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| 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 |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,179.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,415.20
|
| Rate for Payer: Networks By Design Commercial |
$1,149.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,503.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,061.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$884.50
|
| Rate for Payer: United Healthcare All Other HMO |
$884.50
|
| Rate for Payer: United Healthcare HMO Rider |
$884.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$884.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC I & D ABSCESS,THROAT INTRAORAL
|
Facility
|
IP
|
$8,382.00
|
|
|
Service Code
|
CPT 42720
|
| Hospital Charge Code |
900501607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,011.68 |
| Max. Negotiated Rate |
$7,124.70 |
| Rate for Payer: Cash Price |
$3,771.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,352.80
|
| Rate for Payer: Galaxy Health WC |
$7,124.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,029.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,590.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,193.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,011.68
|
| Rate for Payer: Multiplan Commercial |
$6,705.60
|
| Rate for Payer: Networks By Design Commercial |
$5,448.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,124.70
|
|
|
HC I & D ABSCESS,THROAT INTRAORAL
|
Facility
|
OP
|
$8,382.00
|
|
|
Service Code
|
CPT 42720
|
| Hospital Charge Code |
900501607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.63 |
| Max. Negotiated Rate |
$7,124.70 |
| 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 |
$5,029.20
|
| Rate for Payer: Cash Price |
$3,771.90
|
| Rate for Payer: Cash Price |
$3,771.90
|
| Rate for Payer: Cash Price |
$3,771.90
|
| Rate for Payer: Cigna of CA PPO |
$6,202.68
|
| 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 |
$7,124.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,029.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,286.50
|
| 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 |
$5,590.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,011.68
|
| 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 |
$6,705.60
|
| Rate for Payer: Networks By Design Commercial |
$5,448.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,124.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,029.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,191.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,191.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,191.00
|
| 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 I & D ARM BURSA
|
Facility
|
IP
|
$5,896.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
900501660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,415.04 |
| Max. Negotiated Rate |
$5,011.60 |
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,358.40
|
| Rate for Payer: Galaxy Health WC |
$5,011.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,537.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,932.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,246.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,415.04
|
| Rate for Payer: Multiplan Commercial |
$4,716.80
|
| Rate for Payer: Networks By Design Commercial |
$3,832.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,011.60
|
|
|
HC I & D ARM BURSA
|
Facility
|
OP
|
$5,896.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
900501660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$216.45 |
| 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 |
$3,537.60
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cigna of CA PPO |
$4,363.04
|
| 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 |
$5,011.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,537.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,422.00
|
| 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 |
$3,932.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,415.04
|
| 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 |
$4,716.80
|
| Rate for Payer: Networks By Design Commercial |
$3,832.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,011.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,537.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,948.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,948.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,948.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,948.00
|
| 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 I&D BARTHOLIN ABSC
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
900501169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,113.50 |
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
|
|
HC I&D BARTHOLIN ABSC
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
900501169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.97 |
| 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 |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$786.00
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna of CA PPO |
$969.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$982.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$408.31
|
| 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 |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$655.00
|
| Rate for Payer: United Healthcare HMO Rider |
$655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$655.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC I & D COMPL POST-OP WND INF
|
Facility
|
IP
|
$10,819.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
900501007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,596.56 |
| Max. Negotiated Rate |
$9,196.15 |
| Rate for Payer: Cash Price |
$4,868.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,327.60
|
| Rate for Payer: Galaxy Health WC |
$9,196.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,491.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,216.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,122.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,596.56
|
| Rate for Payer: Multiplan Commercial |
$8,655.20
|
| Rate for Payer: Networks By Design Commercial |
$7,032.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,196.15
|
|
|
HC I & D COMPL POST-OP WND INF
|
Facility
|
OP
|
$10,819.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
900501007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.54 |
| Max. Negotiated Rate |
$9,196.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,491.40
|
| Rate for Payer: Cash Price |
$4,868.55
|
| Rate for Payer: Cash Price |
$4,868.55
|
| Rate for Payer: Cash Price |
$4,868.55
|
| Rate for Payer: Cigna of CA PPO |
$8,006.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$9,196.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,491.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,114.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,822.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,822.43
|
| 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 |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,216.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,596.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$8,655.20
|
| Rate for Payer: Networks By Design Commercial |
$7,032.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,196.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,491.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,409.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,409.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,409.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,409.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC I & D COMPL POST-OP WND INF
|
Facility
|
OP
|
$10,819.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
900501007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$223.54 |
| Max. Negotiated Rate |
$9,196.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,491.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,973.60
|
| Rate for Payer: Blue Shield of California EPN |
$6,318.30
|
| Rate for Payer: Cash Price |
$4,868.55
|
| Rate for Payer: Cash Price |
$4,868.55
|
| Rate for Payer: Cigna of CA HMO |
$6,924.16
|
| Rate for Payer: Cigna of CA PPO |
$8,006.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$9,196.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,491.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,114.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,822.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,751.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5,751.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,216.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,596.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$8,655.20
|
| Rate for Payer: Networks By Design Commercial |
$7,032.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,196.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,491.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,491.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,409.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,409.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,409.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,409.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC I & D COMPL POST-OP WND INF
|
Facility
|
IP
|
$10,819.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
900501007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,596.56 |
| Max. Negotiated Rate |
$9,196.15 |
| Rate for Payer: Cash Price |
$4,868.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,327.60
|
| Rate for Payer: Galaxy Health WC |
$9,196.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,491.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,216.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,122.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,596.56
|
| Rate for Payer: Multiplan Commercial |
$8,655.20
|
| Rate for Payer: Networks By Design Commercial |
$7,032.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,196.15
|
|
|
HC I & D DEEP ABSCESS NECK/THORAX
|
Facility
|
OP
|
$8,579.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
900501670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.92 |
| 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 |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,147.40
|
| Rate for Payer: Cash Price |
$3,860.55
|
| Rate for Payer: Cash Price |
$3,860.55
|
| Rate for Payer: Cash Price |
$3,860.55
|
| Rate for Payer: Cigna of CA PPO |
$6,348.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$7,292.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,147.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,434.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,822.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,822.43
|
| 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 |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,722.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,058.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$6,863.20
|
| Rate for Payer: Networks By Design Commercial |
$5,576.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,292.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,147.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,289.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,289.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,289.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,289.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC I & D DEEP ABSCESS NECK/THORAX
|
Facility
|
IP
|
$8,579.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
900501670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,058.96 |
| Max. Negotiated Rate |
$7,292.15 |
| Rate for Payer: Cash Price |
$3,860.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,431.60
|
| Rate for Payer: Galaxy Health WC |
$7,292.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,147.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,722.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,268.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,058.96
|
| Rate for Payer: Multiplan Commercial |
$6,863.20
|
| Rate for Payer: Networks By Design Commercial |
$5,576.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,292.15
|
|
|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.79 |
| 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 |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$709.80
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cigna of CA PPO |
$875.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$887.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| 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 |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$946.40
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$709.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$591.50
|
| Rate for Payer: United Healthcare All Other HMO |
$591.50
|
| Rate for Payer: United Healthcare HMO Rider |
$591.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$591.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.20
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.92
|
| Rate for Payer: Multiplan Commercial |
$946.40
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
|
|
HC IDENTIFY SENTINEL NODE
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.04 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
|
|
HC IDENTIFY SENTINEL NODE
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.04 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$492.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cigna of CA PPO |
$607.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$615.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
