|
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 |
$425.45
|
| Rate for Payer: Blue Shield of California Commercial |
$279.12
|
| Rate for Payer: Blue Shield of California Commercial |
$422.99
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$464.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$421.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$391.17
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$464.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$421.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$391.17
|
| 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
|
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 |
$50.69
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| 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 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 |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| 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 |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California Commercial |
$46.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| 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 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 |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$1,564.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,769.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,721.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4,991.07
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,476.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,967.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$338.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,476.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,967.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,615.57
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$938.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$850.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$790.60
|
| 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 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 |
$2,632.66 |
| Rate for Payer: Adventist Health Commercial |
$268.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,882.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,632.66
|
| Rate for Payer: Blue Shield of California Commercial |
$854.92
|
| Rate for Payer: Blue Shield of California Commercial |
$564.14
|
| 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 |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$938.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| 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/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$695.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$850.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$786.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.32
|
| 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 |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| 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
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
510
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| 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
|
456
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$5,641.00 |
| 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: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$359.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$359.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST BENIGN/PREMAL 2-14 LESION
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
908710139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: EPIC Health Plan Senior |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
|
|
HC DEST BENIGN/PREMAL 2-14 LESION
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
908710139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cigna of CA HMO |
$131.20
|
| Rate for Payer: Cigna of CA PPO |
$151.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$174.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$174.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: EPIC Health Plan Senior |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.50
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.50
|
| Rate for Payer: United Healthcare All Other HMO |
$102.50
|
| Rate for Payer: United Healthcare HMO Rider |
$102.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$174.25
|
| Rate for Payer: Vantage Medical Group Senior |
$174.25
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.33
|
| 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
|
510
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
510
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.33
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.33
|
| 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
|
456
|
| Min. Negotiated Rate |
$92.88 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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: TriValley Medical Group Commercial/Senior |
$232.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
| Rate for Payer: Adventist Health Commercial |
$158.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
