|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
OP
|
$6,052.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.81 |
| 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 |
$5,262.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,631.20
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cigna of CA PPO |
$4,478.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Media |
$3,508.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,736.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,508.15
|
| Rate for Payer: Galaxy Health WC |
$5,144.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,631.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,539.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,753.37
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,753.37
|
| 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 |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,036.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,508.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,700.92
|
| Rate for Payer: Multiplan Commercial |
$4,841.60
|
| Rate for Payer: Networks By Design Commercial |
$3,933.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,144.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,026.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,026.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,026.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,026.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
|
OP
|
$8,189.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$865.83 |
| Max. Negotiated Rate |
$6,960.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,913.40
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Cigna of CA PPO |
$6,059.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$6,960.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,913.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,141.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| 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 |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$865.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,965.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$6,551.20
|
| Rate for Payer: Networks By Design Commercial |
$5,322.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,960.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,094.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,094.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,094.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,094.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
|
IP
|
$8,189.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,965.36 |
| Max. Negotiated Rate |
$6,960.65 |
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,275.60
|
| Rate for Payer: Galaxy Health WC |
$6,960.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,120.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,965.36
|
| Rate for Payer: Multiplan Commercial |
$6,551.20
|
| Rate for Payer: Networks By Design Commercial |
$5,322.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,960.65
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
OP
|
$6,052.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.50 |
| 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 |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,631.20
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cigna of CA PPO |
$4,478.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Media |
$1,474.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$5,144.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,631.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,539.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,418.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,418.05
|
| 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 |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,036.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$4,841.60
|
| Rate for Payer: Networks By Design Commercial |
$3,933.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,144.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,026.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,026.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,026.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,026.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
IP
|
$6,052.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,452.48 |
| Max. Negotiated Rate |
$5,144.20 |
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.80
|
| Rate for Payer: Galaxy Health WC |
$5,144.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,631.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,036.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.48
|
| Rate for Payer: Multiplan Commercial |
$4,841.60
|
| Rate for Payer: Networks By Design Commercial |
$3,933.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,144.20
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
IP
|
$8,561.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,054.64 |
| Max. Negotiated Rate |
$7,276.85 |
| Rate for Payer: Cash Price |
$3,852.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,424.40
|
| Rate for Payer: Galaxy Health WC |
$7,276.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,136.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,261.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.64
|
| Rate for Payer: Multiplan Commercial |
$6,848.80
|
| Rate for Payer: Networks By Design Commercial |
$5,564.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,276.85
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
OP
|
$8,561.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.68 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,136.60
|
| Rate for Payer: Cash Price |
$3,852.45
|
| Rate for Payer: Cash Price |
$3,852.45
|
| Rate for Payer: Cash Price |
$3,852.45
|
| Rate for Payer: Cigna of CA PPO |
$6,335.14
|
| 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 |
$7,276.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,136.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,420.75
|
| 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 |
$5,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.64
|
| 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 |
$6,848.80
|
| Rate for Payer: Networks By Design Commercial |
$5,564.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,276.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,136.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,280.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,280.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,280.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,280.50
|
| 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 INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
OP
|
$8,561.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.68 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,136.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$3,852.45
|
| Rate for Payer: Cash Price |
$3,852.45
|
| Rate for Payer: Cigna of CA PPO |
$6,335.14
|
| 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 |
$7,276.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,136.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,420.75
|
| 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 |
$5,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.64
|
| 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 |
$6,848.80
|
| Rate for Payer: Networks By Design Commercial |
$5,564.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,276.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,136.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
IP
|
$8,561.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,054.64 |
| Max. Negotiated Rate |
$7,276.85 |
| Rate for Payer: Cash Price |
$3,852.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,424.40
|
| Rate for Payer: Galaxy Health WC |
$7,276.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,136.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,261.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.64
|
| Rate for Payer: Multiplan Commercial |
$6,848.80
|
| Rate for Payer: Networks By Design Commercial |
$5,564.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,276.85
|
|
|
HC INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
OP
|
$8,820.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.41 |
| Max. Negotiated Rate |
$7,497.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,292.00
|
| Rate for Payer: Cash Price |
$3,969.00
|
| Rate for Payer: Cash Price |
$3,969.00
|
| Rate for Payer: Cash Price |
$3,969.00
|
| Rate for Payer: Cigna of CA PPO |
$6,526.80
|
| 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 |
$7,497.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,292.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,615.00
|
| 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 |
$5,882.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,116.80
|
| 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 |
$7,056.00
|
| Rate for Payer: Networks By Design Commercial |
$5,733.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,497.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,292.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,410.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,410.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,410.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,410.00
|
| 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 INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
IP
|
$8,820.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$7,497.00 |
| Rate for Payer: Cash Price |
$3,969.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,528.00
|
| Rate for Payer: Galaxy Health WC |
$7,497.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,292.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,882.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,360.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,116.80
|
| Rate for Payer: Multiplan Commercial |
$7,056.00
|
| Rate for Payer: Networks By Design Commercial |
$5,733.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,497.00
|
|
|
HC INCISION FINGER TENDON EACH
|
Facility
|
IP
|
$7,945.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,906.80 |
| Max. Negotiated Rate |
$6,753.25 |
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,178.00
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,027.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.80
|
| Rate for Payer: Multiplan Commercial |
$6,356.00
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
|
|
HC INCISION FINGER TENDON EACH
|
Facility
|
OP
|
$7,945.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,767.00
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cigna of CA PPO |
$5,879.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,958.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| 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 |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$6,356.00
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,767.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,972.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,972.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,972.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC INCISION LINGUAL FRENUM
|
Facility
|
OP
|
$5,766.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| 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 |
$3,459.60
|
| Rate for Payer: Cash Price |
$2,594.70
|
| Rate for Payer: Cash Price |
$2,594.70
|
| Rate for Payer: Cash Price |
$2,594.70
|
| Rate for Payer: Cigna of CA PPO |
$4,266.84
|
| 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 |
$4,901.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,459.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,324.50
|
| 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 |
$3,845.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,383.84
|
| 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 |
$4,612.80
|
| Rate for Payer: Networks By Design Commercial |
$3,747.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,459.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,883.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,883.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,883.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,883.00
|
| 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
|
|
|
HC INCISION LINGUAL FRENUM
|
Facility
|
IP
|
$5,766.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,383.84 |
| Max. Negotiated Rate |
$4,901.10 |
| Rate for Payer: Cash Price |
$2,594.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.40
|
| Rate for Payer: Galaxy Health WC |
$4,901.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,459.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,845.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,196.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,383.84
|
| Rate for Payer: Multiplan Commercial |
$4,612.80
|
| Rate for Payer: Networks By Design Commercial |
$3,747.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.10
|
|
|
HC INCISION OF EYE
|
Facility
|
IP
|
$6,322.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,517.28 |
| Max. Negotiated Rate |
$5,373.70 |
| Rate for Payer: Cash Price |
$2,844.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,528.80
|
| Rate for Payer: Galaxy Health WC |
$5,373.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,793.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,216.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,408.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,517.28
|
| Rate for Payer: Multiplan Commercial |
$5,057.60
|
| Rate for Payer: Networks By Design Commercial |
$4,109.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,373.70
|
|
|
HC INCISION OF EYE
|
Facility
|
OP
|
$6,322.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.46 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,793.20
|
| Rate for Payer: Cash Price |
$2,844.90
|
| Rate for Payer: Cash Price |
$2,844.90
|
| Rate for Payer: Cash Price |
$2,844.90
|
| Rate for Payer: Cigna of CA PPO |
$4,678.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$5,373.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,793.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,741.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,775.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,775.07
|
| 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 |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,216.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,517.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$5,057.60
|
| Rate for Payer: Networks By Design Commercial |
$4,109.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,373.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,793.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,161.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,161.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.08 |
| Max. Negotiated Rate |
$991.95 |
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.80
|
| Rate for Payer: Galaxy Health WC |
$991.95
|
| Rate for Payer: Global Benefits Group Commercial |
$700.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$778.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.08
|
| Rate for Payer: Multiplan Commercial |
$933.60
|
| Rate for Payer: Networks By Design Commercial |
$758.55
|
| Rate for Payer: Prime Health Services Commercial |
$991.95
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.08 |
| 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 |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$700.20
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cigna of CA PPO |
$863.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$991.95
|
| Rate for Payer: Global Benefits Group Commercial |
$700.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$875.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| 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 |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$778.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$933.60
|
| Rate for Payer: Networks By Design Commercial |
$758.55
|
| Rate for Payer: Prime Health Services Commercial |
$991.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$700.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.50
|
| Rate for Payer: United Healthcare All Other HMO |
$583.50
|
| Rate for Payer: United Healthcare HMO Rider |
$583.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$583.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC INCISION OF URETHRA
|
Facility
|
IP
|
$6,947.00
|
|
|
Service Code
|
CPT 53000
|
| Hospital Charge Code |
902400991
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,667.28 |
| Max. Negotiated Rate |
$5,904.95 |
| Rate for Payer: Cash Price |
$3,126.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,778.80
|
| Rate for Payer: Galaxy Health WC |
$5,904.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,168.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,646.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,667.28
|
| Rate for Payer: Multiplan Commercial |
$5,557.60
|
| Rate for Payer: Networks By Design Commercial |
$4,515.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,904.95
|
|
|
HC INCISION OF URETHRA
|
Facility
|
OP
|
$6,947.00
|
|
|
Service Code
|
CPT 53000
|
| Hospital Charge Code |
902400991
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$293.55 |
| Max. Negotiated Rate |
$5,904.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,168.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,119.94
|
| Rate for Payer: Blue Shield of California EPN |
$4,057.05
|
| Rate for Payer: Cash Price |
$3,126.15
|
| Rate for Payer: Cash Price |
$3,126.15
|
| Rate for Payer: Cash Price |
$3,126.15
|
| Rate for Payer: Cigna of CA HMO |
$4,446.08
|
| Rate for Payer: Cigna of CA PPO |
$5,140.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$5,904.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,168.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,210.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,667.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$5,557.60
|
| Rate for Payer: Networks By Design Commercial |
$4,515.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,904.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,168.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,168.20
|
| 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 |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$308.79 |
| 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 |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,182.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,452.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,151.06
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cigna of CA HMO |
$1,261.44
|
| Rate for Payer: Cigna of CA PPO |
$1,458.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,478.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$1,281.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,182.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,182.60
|
| 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 |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$473.04 |
| Max. Negotiated Rate |
$1,675.35 |
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$1,281.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.79 |
| 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 |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,182.60
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cigna of CA PPO |
$1,458.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,478.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| 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 |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$1,281.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,182.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$985.50
|
| Rate for Payer: United Healthcare All Other HMO |
$985.50
|
| Rate for Payer: United Healthcare HMO Rider |
$985.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$985.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$473.04 |
| Max. Negotiated Rate |
$1,675.35 |
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$1,281.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
|
