|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
940100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
940100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947200113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
OP
|
$4,137.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.27 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,482.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: Cigna of CA PPO |
$3,061.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$3,516.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,482.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,102.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,759.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$3,309.60
|
| Rate for Payer: Networks By Design Commercial |
$2,689.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,516.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,482.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
IP
|
$4,137.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$992.88 |
| Max. Negotiated Rate |
$3,516.45 |
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,654.80
|
| Rate for Payer: Galaxy Health WC |
$3,516.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,482.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,759.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.88
|
| Rate for Payer: Multiplan Commercial |
$3,309.60
|
| Rate for Payer: Networks By Design Commercial |
$2,689.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,516.45
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
OP
|
$6,771.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.37 |
| 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 |
$7,246.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,830.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,062.60
|
| Rate for Payer: Cash Price |
$3,046.95
|
| Rate for Payer: Cash Price |
$3,046.95
|
| Rate for Payer: Cash Price |
$3,046.95
|
| Rate for Payer: Cigna of CA PPO |
$5,010.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Dignity Health Media |
$4,830.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,313.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,521.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,830.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,830.79
|
| Rate for Payer: Galaxy Health WC |
$5,755.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,062.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,078.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,922.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,922.50
|
| 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 |
$4,830.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,830.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,086.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,473.26
|
| Rate for Payer: Multiplan Commercial |
$5,416.80
|
| Rate for Payer: Networks By Design Commercial |
$4,401.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,755.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,385.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,385.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,385.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,385.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4,830.79
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
IP
|
$6,771.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,625.04 |
| Max. Negotiated Rate |
$5,755.35 |
| Rate for Payer: Cash Price |
$3,046.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,708.40
|
| Rate for Payer: Galaxy Health WC |
$5,755.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,579.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.04
|
| Rate for Payer: Multiplan Commercial |
$5,416.80
|
| Rate for Payer: Networks By Design Commercial |
$4,401.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,755.35
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
OP
|
$7,932.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| 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 |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,759.20
|
| Rate for Payer: Cash Price |
$3,569.40
|
| Rate for Payer: Cash Price |
$3,569.40
|
| Rate for Payer: Cash Price |
$3,569.40
|
| Rate for Payer: Cigna of CA PPO |
$5,869.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,742.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,759.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,949.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| 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 |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,158.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,903.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,345.60
|
| Rate for Payer: Networks By Design Commercial |
$5,155.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,742.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,759.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,966.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,966.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,966.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,966.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
IP
|
$7,932.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,903.68 |
| Max. Negotiated Rate |
$6,742.20 |
| Rate for Payer: Cash Price |
$3,569.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.80
|
| Rate for Payer: Galaxy Health WC |
$6,742.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,759.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,022.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,903.68
|
| Rate for Payer: Multiplan Commercial |
$6,345.60
|
| Rate for Payer: Networks By Design Commercial |
$5,155.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,742.20
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
IP
|
$6,269.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,504.56 |
| Max. Negotiated Rate |
$5,328.65 |
| Rate for Payer: Cash Price |
$2,821.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,507.60
|
| Rate for Payer: Galaxy Health WC |
$5,328.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,761.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,388.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.56
|
| Rate for Payer: Multiplan Commercial |
$5,015.20
|
| Rate for Payer: Networks By Design Commercial |
$4,074.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,328.65
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
OP
|
$6,269.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,761.40
|
| Rate for Payer: Cash Price |
$2,821.05
|
| Rate for Payer: Cash Price |
$2,821.05
|
| Rate for Payer: Cash Price |
$2,821.05
|
| Rate for Payer: Cigna of CA PPO |
$4,639.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$5,328.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,761.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,701.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| 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 |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,980.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$5,015.20
|
| Rate for Payer: Networks By Design Commercial |
$4,074.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,328.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,761.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,134.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,134.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,134.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
OP
|
$6,269.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.22 |
| 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 |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,761.40
|
| Rate for Payer: Cash Price |
$2,821.05
|
| Rate for Payer: Cash Price |
$2,821.05
|
| Rate for Payer: Cash Price |
$2,821.05
|
| Rate for Payer: Cigna of CA PPO |
$4,639.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$5,328.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,761.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,701.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| 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 |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$5,015.20
|
| Rate for Payer: Networks By Design Commercial |
$4,074.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,328.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,761.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,134.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,134.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,134.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
IP
|
$6,269.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,504.56 |
| Max. Negotiated Rate |
$5,328.65 |
| Rate for Payer: Cash Price |
$2,821.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,507.60
|
| Rate for Payer: Galaxy Health WC |
$5,328.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,761.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,388.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.56
|
| Rate for Payer: Multiplan Commercial |
$5,015.20
|
| Rate for Payer: Networks By Design Commercial |
$4,074.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,328.65
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
OP
|
$2,277.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$546.48 |
| 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 |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,366.20
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Cigna of CA PPO |
$1,684.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,935.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,707.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,286.92
|
| 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 |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,518.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,821.60
|
| Rate for Payer: Networks By Design Commercial |
$1,480.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,935.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,366.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,138.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,138.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,138.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,138.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
IP
|
$2,277.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$546.48 |
| Max. Negotiated Rate |
$1,935.45 |
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.80
|
| Rate for Payer: Galaxy Health WC |
$1,935.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,518.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.48
|
| Rate for Payer: Multiplan Commercial |
$1,821.60
|
| Rate for Payer: Networks By Design Commercial |
$1,480.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,935.45
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$1,687.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$404.88 |
| Max. Negotiated Rate |
$1,433.95 |
| Rate for Payer: Cash Price |
$759.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.80
|
| Rate for Payer: Galaxy Health WC |
$1,433.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.88
|
| Rate for Payer: Multiplan Commercial |
$1,349.60
|
| Rate for Payer: Networks By Design Commercial |
$1,096.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,433.95
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$1,687.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.46 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,012.20
|
| Rate for Payer: Cash Price |
$759.15
|
| Rate for Payer: Cash Price |
$759.15
|
| Rate for Payer: Cash Price |
$759.15
|
| Rate for Payer: Cigna of CA PPO |
$1,248.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,433.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,265.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,349.60
|
| Rate for Payer: Networks By Design Commercial |
$1,096.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,433.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,012.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$843.50
|
| Rate for Payer: United Healthcare All Other HMO |
$843.50
|
| Rate for Payer: United Healthcare HMO Rider |
$843.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$843.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$1,451.80 |
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$683.20
|
| Rate for Payer: Galaxy Health WC |
$1,451.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,139.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Networks By Design Commercial |
$1,110.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,451.80
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,024.80
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna of CA PPO |
$1,263.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,451.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,281.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,286.92
|
| 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 |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,139.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Networks By Design Commercial |
$1,110.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,451.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,024.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$854.00
|
| Rate for Payer: United Healthcare All Other HMO |
$854.00
|
| Rate for Payer: United Healthcare HMO Rider |
$854.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
|
IP
|
$3,080.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$739.20 |
| Max. Negotiated Rate |
$2,618.00 |
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,232.00
|
| Rate for Payer: Galaxy Health WC |
$2,618.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,848.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,173.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.20
|
| Rate for Payer: Multiplan Commercial |
$2,464.00
|
| Rate for Payer: Networks By Design Commercial |
$2,002.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,618.00
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
|
OP
|
$3,080.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.87 |
| 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 |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,848.00
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cigna of CA PPO |
$2,279.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,618.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,848.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,310.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,286.92
|
| 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 |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$2,464.00
|
| Rate for Payer: Networks By Design Commercial |
$2,002.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,618.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,848.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,540.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,540.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,540.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,540.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$1,868.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.32 |
| 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 |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,120.80
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cigna of CA PPO |
$1,382.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,401.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,286.92
|
| 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 |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,494.40
|
| Rate for Payer: Networks By Design Commercial |
$1,214.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,120.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$934.00
|
| Rate for Payer: United Healthcare All Other HMO |
$934.00
|
| Rate for Payer: United Healthcare HMO Rider |
$934.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$934.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$1,868.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.32 |
| Max. Negotiated Rate |
$1,587.80 |
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.32
|
| Rate for Payer: Multiplan Commercial |
$1,494.40
|
| Rate for Payer: Networks By Design Commercial |
$1,214.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
|
