|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$322.15 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$322.15 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$423.83 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.74
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.50
|
| Rate for Payer: United Healthcare All Other HMO |
$189.50
|
| Rate for Payer: United Healthcare HMO Rider |
$189.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
915353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
905353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
905353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$72.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.10
|
| Rate for Payer: Blue Shield of California Commercial |
$131.36
|
| Rate for Payer: Blue Shield of California EPN |
$86.51
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
915353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$72.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.10
|
| Rate for Payer: Blue Shield of California Commercial |
$131.36
|
| Rate for Payer: Blue Shield of California EPN |
$86.51
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
OP
|
$663.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$563.55 |
| Rate for Payer: Adventist Health Commercial |
$132.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$434.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$563.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.15
|
| Rate for Payer: Blue Shield of California Commercial |
$405.76
|
| Rate for Payer: Blue Shield of California EPN |
$267.85
|
| Rate for Payer: Cash Price |
$298.35
|
| Rate for Payer: Cigna of CA HMO |
$424.32
|
| Rate for Payer: Cigna of CA PPO |
$490.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$563.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$563.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$563.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$410.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$464.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$464.10
|
| Rate for Payer: Multiplan Commercial |
$530.40
|
| Rate for Payer: Networks By Design Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.50
|
| Rate for Payer: United Healthcare All Other HMO |
$331.50
|
| Rate for Payer: United Healthcare HMO Rider |
$331.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$563.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$563.55
|
| Rate for Payer: Vantage Medical Group Senior |
$563.55
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
IP
|
$663.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$563.55 |
| Rate for Payer: Adventist Health Commercial |
$132.60
|
| Rate for Payer: Cash Price |
$298.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$410.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.12
|
| Rate for Payer: Multiplan Commercial |
$530.40
|
| Rate for Payer: Networks By Design Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
|
|
HC DERMABOND
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC DERMABOND
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.51
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$44.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.17
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
IP
|
$7,823.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,564.60 |
| Max. Negotiated Rate |
$6,649.55 |
| Rate for Payer: Adventist Health Commercial |
$1,564.60
|
| Rate for Payer: Cash Price |
$3,520.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,129.20
|
| Rate for Payer: Galaxy Health WC |
$6,649.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,693.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,217.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,980.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,842.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.52
|
| Rate for Payer: Multiplan Commercial |
$6,258.40
|
| Rate for Payer: Networks By Design Commercial |
$5,084.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,649.55
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
OP
|
$7,823.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$299.31 |
| Max. Negotiated Rate |
$6,649.55 |
| Rate for Payer: Adventist Health Commercial |
$1,564.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,131.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4,787.68
|
| Rate for Payer: Blue Shield of California EPN |
$3,160.49
|
| Rate for Payer: Cash Price |
$3,520.35
|
| Rate for Payer: Cash Price |
$3,520.35
|
| Rate for Payer: Cigna of CA HMO |
$5,006.72
|
| Rate for Payer: Cigna of CA PPO |
$5,789.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,649.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,693.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,217.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$6,258.40
|
| Rate for Payer: Networks By Design Commercial |
$5,084.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,649.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,693.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,693.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
IP
|
$10,583.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906820023
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,116.60 |
| Max. Negotiated Rate |
$8,995.55 |
| Rate for Payer: Adventist Health Commercial |
$2,116.60
|
| Rate for Payer: Cash Price |
$4,762.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,233.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,233.20
|
| Rate for Payer: Galaxy Health WC |
$8,995.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,349.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,058.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,032.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,550.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.92
|
| Rate for Payer: Multiplan Commercial |
$8,466.40
|
| Rate for Payer: Networks By Design Commercial |
$6,878.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,995.55
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
OP
|
$10,583.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906820023
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$299.31 |
| Max. Negotiated Rate |
$8,995.55 |
| Rate for Payer: Adventist Health Commercial |
$2,116.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,941.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,476.80
|
| Rate for Payer: Blue Shield of California EPN |
$4,275.53
|
| Rate for Payer: Cash Price |
$4,762.35
|
| Rate for Payer: Cash Price |
$4,762.35
|
| Rate for Payer: Cigna of CA HMO |
$6,773.12
|
| Rate for Payer: Cigna of CA PPO |
$7,831.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,995.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,349.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,058.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,466.40
|
| Rate for Payer: Networks By Design Commercial |
$6,878.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,995.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC DESIGN MIC DEVICE FOR IMRT
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
909100215
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$2,519.31 |
| Rate for Payer: Adventist Health Commercial |
$268.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$878.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,519.31
|
| Rate for Payer: Blue Shield of California Commercial |
$820.08
|
| Rate for Payer: Blue Shield of California EPN |
$541.36
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna of CA HMO |
$857.60
|
| Rate for Payer: Cigna of CA PPO |
$991.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$1,139.00
|
| Rate for Payer: Global Benefits Group Commercial |
$804.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$695.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: Networks By Design Commercial |
$871.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$804.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC DESIGN MIC DEVICE FOR IMRT
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
909100215
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$1,139.00 |
| Rate for Payer: Adventist Health Commercial |
$268.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.00
|
| Rate for Payer: EPIC Health Plan Senior |
$536.00
|
| Rate for Payer: Galaxy Health WC |
$1,139.00
|
| Rate for Payer: Global Benefits Group Commercial |
$804.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$829.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: Networks By Design Commercial |
$871.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.00
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$168.96
|
| Rate for Payer: Cigna of CA PPO |
$195.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.00
|
| Rate for Payer: United Healthcare All Other HMO |
$132.00
|
| Rate for Payer: United Healthcare HMO Rider |
$132.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$328.95 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$239.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cigna of CA HMO |
$247.68
|
| Rate for Payer: Cigna of CA PPO |
$286.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.50
|
| Rate for Payer: United Healthcare All Other HMO |
$193.50
|
| Rate for Payer: United Healthcare HMO Rider |
$193.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$455.68
|
| Rate for Payer: Cigna of CA PPO |
$526.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$356.00
|
| Rate for Payer: United Healthcare All Other HMO |
$356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$356.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
