|
HC DPT ADMINISTRATION
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
908603026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC DPT ADMINISTRATION
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
908603026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC DRAINABLE POUCH FLEX WIDE RED
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608071
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
HC DRAINABLE POUCH FLEX WIDE RED
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608071
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
HC DRAINABLE POUCH FLEX YELLOW
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608072
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.26
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
HC DRAINABLE POUCH FLEX YELLOW
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608072
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
|
|
HC DRAIN ABSCESS CYST HEM VISTIB
|
Facility
|
OP
|
$1,447.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
900501236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$289.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$651.15
|
| Rate for Payer: Cash Price |
$651.15
|
| Rate for Payer: Cash Price |
$651.15
|
| Rate for Payer: Cigna of CA HMO |
$926.08
|
| Rate for Payer: Cigna of CA PPO |
$1,070.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,229.95
|
| Rate for Payer: Global Benefits Group Commercial |
$868.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$965.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,157.60
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$940.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,229.95
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$868.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$723.50
|
| Rate for Payer: United Healthcare All Other HMO |
$723.50
|
| Rate for Payer: United Healthcare HMO Rider |
$723.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC DRAIN ABSCESS CYST HEM VISTIB
|
Facility
|
IP
|
$1,447.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
900501236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.40 |
| Max. Negotiated Rate |
$1,229.95 |
| Rate for Payer: Adventist Health Commercial |
$289.40
|
| Rate for Payer: Cash Price |
$651.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$578.80
|
| Rate for Payer: EPIC Health Plan Senior |
$578.80
|
| Rate for Payer: Galaxy Health WC |
$1,229.95
|
| Rate for Payer: Global Benefits Group Commercial |
$868.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$965.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$895.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.28
|
| Rate for Payer: Multiplan Commercial |
$1,157.60
|
| Rate for Payer: Networks By Design Commercial |
$940.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,229.95
|
|
|
HC DRAIN ABSCESS/HEMATOMA,NASAL
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
900501594
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cigna of CA HMO |
$643.84
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$503.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$503.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC DRAIN ABSCESS/HEMATOMA,NASAL
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
900501594
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$855.10 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC DRAIN ABSCESS PALATE UVULA
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
900501466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna of CA HMO |
$509.44
|
| Rate for Payer: Cigna of CA PPO |
$589.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.00
|
| Rate for Payer: United Healthcare All Other HMO |
$398.00
|
| Rate for Payer: United Healthcare HMO Rider |
$398.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC DRAIN ABSCESS PALATE UVULA
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
900501466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
|
|
HC DRAINAGE BAG FOR DUET SYSTEM
|
Facility
|
OP
|
$307.44
|
|
| Hospital Charge Code |
901698471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$261.32 |
| Rate for Payer: Adventist Health Commercial |
$61.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$230.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.80
|
| Rate for Payer: Cash Price |
$138.35
|
| Rate for Payer: Cigna of CA HMO |
$196.76
|
| Rate for Payer: Cigna of CA PPO |
$227.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$261.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.98
|
| Rate for Payer: EPIC Health Plan Senior |
$122.98
|
| Rate for Payer: Galaxy Health WC |
$261.32
|
| Rate for Payer: Global Benefits Group Commercial |
$184.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$215.21
|
| Rate for Payer: Multiplan Commercial |
$245.95
|
| Rate for Payer: Networks By Design Commercial |
$199.84
|
| Rate for Payer: Prime Health Services Commercial |
$261.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.72
|
| Rate for Payer: United Healthcare All Other HMO |
$153.72
|
| Rate for Payer: United Healthcare HMO Rider |
$153.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.32
|
| Rate for Payer: Vantage Medical Group Senior |
$261.32
|
|
|
HC DRAINAGE BAG FOR DUET SYSTEM
|
Facility
|
IP
|
$307.44
|
|
| Hospital Charge Code |
901698471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$261.32 |
| Rate for Payer: Adventist Health Commercial |
$61.49
|
| Rate for Payer: Cash Price |
$138.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.98
|
| Rate for Payer: EPIC Health Plan Senior |
$122.98
|
| Rate for Payer: Galaxy Health WC |
$261.32
|
| Rate for Payer: Global Benefits Group Commercial |
$184.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.79
|
| Rate for Payer: Multiplan Commercial |
$245.95
|
| Rate for Payer: Networks By Design Commercial |
$199.84
|
| Rate for Payer: Prime Health Services Commercial |
$261.32
|
|
|
HC DRAINAGE BAG INTRACRANIAL PRES
|
Facility
|
IP
|
$259.70
|
|
| Hospital Charge Code |
901698697
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$220.75 |
| Rate for Payer: Adventist Health Commercial |
$51.94
|
| Rate for Payer: Cash Price |
$116.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.88
|
| Rate for Payer: EPIC Health Plan Senior |
$103.88
|
| Rate for Payer: Galaxy Health WC |
$220.75
|
| Rate for Payer: Global Benefits Group Commercial |
$155.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.33
|
| Rate for Payer: Multiplan Commercial |
$207.76
|
| Rate for Payer: Networks By Design Commercial |
$168.81
|
| Rate for Payer: Prime Health Services Commercial |
$220.75
|
|
|
HC DRAINAGE BAG INTRACRANIAL PRES
|
Facility
|
OP
|
$259.70
|
|
| Hospital Charge Code |
901698697
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$220.75 |
| Rate for Payer: Adventist Health Commercial |
$51.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.48
|
| Rate for Payer: Cash Price |
$116.86
|
| Rate for Payer: Cigna of CA HMO |
$166.21
|
| Rate for Payer: Cigna of CA PPO |
$192.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.88
|
| Rate for Payer: EPIC Health Plan Senior |
$103.88
|
| Rate for Payer: Galaxy Health WC |
$220.75
|
| Rate for Payer: Global Benefits Group Commercial |
$155.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.79
|
| Rate for Payer: Multiplan Commercial |
$207.76
|
| Rate for Payer: Networks By Design Commercial |
$168.81
|
| Rate for Payer: Prime Health Services Commercial |
$220.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.85
|
| Rate for Payer: United Healthcare All Other HMO |
$129.85
|
| Rate for Payer: United Healthcare HMO Rider |
$129.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.75
|
| Rate for Payer: Vantage Medical Group Senior |
$220.75
|
|
|
HC DRAINAGE BAG MONITORR ICP
|
Facility
|
IP
|
$975.20
|
|
| Hospital Charge Code |
901698777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.04 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Adventist Health Commercial |
$195.04
|
| Rate for Payer: Cash Price |
$438.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.08
|
| Rate for Payer: EPIC Health Plan Senior |
$390.08
|
| Rate for Payer: Galaxy Health WC |
$828.92
|
| Rate for Payer: Global Benefits Group Commercial |
$585.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$650.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$603.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.05
|
| Rate for Payer: Multiplan Commercial |
$780.16
|
| Rate for Payer: Networks By Design Commercial |
$633.88
|
| Rate for Payer: Prime Health Services Commercial |
$828.92
|
|
|
HC DRAINAGE BAG MONITORR ICP
|
Facility
|
OP
|
$975.20
|
|
| Hospital Charge Code |
901698777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.04 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Adventist Health Commercial |
$195.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$639.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$828.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$536.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$731.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.87
|
| Rate for Payer: Cash Price |
$438.84
|
| Rate for Payer: Cigna of CA HMO |
$624.13
|
| Rate for Payer: Cigna of CA PPO |
$721.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$828.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$828.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$828.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.08
|
| Rate for Payer: EPIC Health Plan Senior |
$390.08
|
| Rate for Payer: Galaxy Health WC |
$828.92
|
| Rate for Payer: Global Benefits Group Commercial |
$585.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$650.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$603.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$682.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$682.64
|
| Rate for Payer: Multiplan Commercial |
$780.16
|
| Rate for Payer: Networks By Design Commercial |
$633.88
|
| Rate for Payer: Prime Health Services Commercial |
$828.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$585.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$585.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$487.60
|
| Rate for Payer: United Healthcare All Other HMO |
$487.60
|
| Rate for Payer: United Healthcare HMO Rider |
$487.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$828.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$828.92
|
| Rate for Payer: Vantage Medical Group Senior |
$828.92
|
|
|
HC DRAINAGE OF EYE
|
Facility
|
OP
|
$6,017.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,707.65
|
| Rate for Payer: Cash Price |
$2,707.65
|
| Rate for Payer: Cash Price |
$2,707.65
|
| Rate for Payer: Cigna of CA HMO |
$3,850.88
|
| Rate for Payer: Cigna of CA PPO |
$4,452.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$5,114.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,610.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,013.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,444.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,813.60
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,911.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,114.45
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,008.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,008.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,008.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,008.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC DRAINAGE OF EYE
|
Facility
|
IP
|
$6,017.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,203.40 |
| Max. Negotiated Rate |
$5,114.45 |
| Rate for Payer: Adventist Health Commercial |
$1,203.40
|
| Rate for Payer: Cash Price |
$2,707.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,406.80
|
| Rate for Payer: Galaxy Health WC |
$5,114.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,013.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,724.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,444.08
|
| Rate for Payer: Multiplan Commercial |
$4,813.60
|
| Rate for Payer: Networks By Design Commercial |
$3,911.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,114.45
|
|
|
HC DRAINAGE OF SALIVARY GLAND
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
900501363
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cigna of CA HMO |
$616.32
|
| Rate for Payer: Cigna of CA PPO |
$712.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.50
|
| Rate for Payer: United Healthcare All Other HMO |
$481.50
|
| Rate for Payer: United Healthcare HMO Rider |
$481.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$481.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC DRAINAGE OF SALIVARY GLAND
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
900501363
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$818.55 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.12
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
|
|
HC DRAINAGE/ SCROTAL WALL ABSCESS
|
Facility
|
OP
|
$6,882.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
900501614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$370.67 |
| Max. Negotiated Rate |
$5,849.70 |
| Rate for Payer: Adventist Health Commercial |
$1,376.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,096.90
|
| Rate for Payer: Cash Price |
$3,096.90
|
| Rate for Payer: Cash Price |
$3,096.90
|
| Rate for Payer: Cigna of CA HMO |
$4,404.48
|
| Rate for Payer: Cigna of CA PPO |
$5,092.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,849.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,129.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,590.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$5,505.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,473.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,849.70
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,441.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,441.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,441.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC DRAINAGE/ SCROTAL WALL ABSCESS
|
Facility
|
IP
|
$6,882.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
900501614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,376.40 |
| Max. Negotiated Rate |
$5,849.70 |
| Rate for Payer: Adventist Health Commercial |
$1,376.40
|
| Rate for Payer: Cash Price |
$3,096.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,752.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,752.80
|
| Rate for Payer: Galaxy Health WC |
$5,849.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,129.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,590.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,622.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,259.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.68
|
| Rate for Payer: Multiplan Commercial |
$5,505.60
|
| Rate for Payer: Networks By Design Commercial |
$4,473.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,849.70
|
|
|
HC DRAIN CHEST ATRIUM
|
Facility
|
IP
|
$287.28
|
|
| Hospital Charge Code |
901600595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$244.19 |
| Rate for Payer: Adventist Health Commercial |
$57.46
|
| Rate for Payer: Cash Price |
$129.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.91
|
| Rate for Payer: EPIC Health Plan Senior |
$114.91
|
| Rate for Payer: Galaxy Health WC |
$244.19
|
| Rate for Payer: Global Benefits Group Commercial |
$172.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.95
|
| Rate for Payer: Multiplan Commercial |
$229.82
|
| Rate for Payer: Networks By Design Commercial |
$186.73
|
| Rate for Payer: Prime Health Services Commercial |
$244.19
|
|
