|
HC EWHFO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
915353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,172.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,494.45
|
| Rate for Payer: Blue Shield of California EPN |
$984.15
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,304.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,417.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
915353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
905353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,172.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,494.45
|
| Rate for Payer: Blue Shield of California EPN |
$984.15
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,304.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,417.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
905353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHO FX OX COLLES FX
|
Facility
|
OP
|
$2,053.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$492.72 |
| Max. Negotiated Rate |
$1,745.05 |
| Rate for Payer: Adventist Health Commercial |
$841.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,745.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,129.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,189.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,515.11
|
| Rate for Payer: Blue Shield of California EPN |
$997.76
|
| Rate for Payer: Cash Price |
$923.85
|
| Rate for Payer: Cash Price |
$923.85
|
| Rate for Payer: Cigna of CA HMO |
$1,437.10
|
| Rate for Payer: Cigna of CA PPO |
$1,437.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,745.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,745.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,745.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$821.20
|
| Rate for Payer: Galaxy Health WC |
$1,745.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,231.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,369.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,270.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,437.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,437.10
|
| Rate for Payer: Multiplan Commercial |
$1,642.40
|
| Rate for Payer: Networks By Design Commercial |
$1,026.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,745.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,231.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,231.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$770.49
|
| Rate for Payer: United Healthcare All Other HMO |
$749.96
|
| Rate for Payer: United Healthcare HMO Rider |
$733.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$672.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,745.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,745.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,745.05
|
|
|
HC EWHO FX OX COLLES FX
|
Facility
|
IP
|
$2,053.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$410.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$410.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$923.85
|
| Rate for Payer: Cash Price |
$923.85
|
| Rate for Payer: Cigna of CA HMO |
$1,437.10
|
| Rate for Payer: Cigna of CA PPO |
$1,437.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$821.20
|
| Rate for Payer: Galaxy Health WC |
$1,745.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,231.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,369.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$782.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,270.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.72
|
| Rate for Payer: Multiplan Commercial |
$1,642.40
|
| Rate for Payer: Networks By Design Commercial |
$1,026.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,745.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$770.49
|
| Rate for Payer: United Healthcare All Other HMO |
$749.96
|
| Rate for Payer: United Healthcare HMO Rider |
$733.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$672.36
|
|
|
HC EWHO FX OX WHO HINGE
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$537.00
|
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO |
$751.80
|
| Rate for Payer: Cigna of CA PPO |
$751.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: EPIC Health Plan Senior |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$664.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.76
|
| Rate for Payer: Multiplan Commercial |
$859.20
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$403.07
|
| Rate for Payer: United Healthcare All Other HMO |
$392.33
|
| Rate for Payer: United Healthcare HMO Rider |
$383.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.74
|
|
|
HC EWHO FX OX WHO HINGE
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$257.76 |
| Max. Negotiated Rate |
$1,475.88 |
| Rate for Payer: Adventist Health Commercial |
$440.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$805.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$622.06
|
| Rate for Payer: Blue Shield of California Commercial |
$792.61
|
| Rate for Payer: Blue Shield of California EPN |
$521.96
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO |
$751.80
|
| Rate for Payer: Cigna of CA PPO |
$751.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: EPIC Health Plan Senior |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,304.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$664.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$751.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$751.80
|
| Rate for Payer: Multiplan Commercial |
$859.20
|
| Rate for Payer: Networks By Design Commercial |
$537.00
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$644.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$644.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$403.07
|
| Rate for Payer: United Healthcare All Other HMO |
$392.33
|
| Rate for Payer: United Healthcare HMO Rider |
$383.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
915353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,627.75 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,109.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,413.27
|
| Rate for Payer: Blue Shield of California EPN |
$930.69
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
915353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,627.75 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,109.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,413.27
|
| Rate for Payer: Blue Shield of California EPN |
$930.69
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
915353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,172.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,494.45
|
| Rate for Payer: Blue Shield of California EPN |
$984.15
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,304.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,417.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cigna of CA HMO |
$1,466.50
|
| Rate for Payer: Cigna of CA PPO |
$1,466.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,397.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,296.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.80
|
| Rate for Payer: Multiplan Commercial |
$1,676.00
|
| Rate for Payer: Networks By Design Commercial |
$1,047.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.25
|
| Rate for Payer: United Healthcare All Other HMO |
$765.30
|
| Rate for Payer: United Healthcare HMO Rider |
$748.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.11
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
915353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.80 |
| Max. Negotiated Rate |
$1,780.75 |
| Rate for Payer: Adventist Health Commercial |
$858.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,152.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,571.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,213.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,546.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,018.17
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cigna of CA HMO |
$1,466.50
|
| Rate for Payer: Cigna of CA PPO |
$1,466.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,780.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,780.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,304.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,397.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,296.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,466.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,466.50
|
| Rate for Payer: Multiplan Commercial |
$1,676.00
|
| Rate for Payer: Networks By Design Commercial |
$1,047.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,257.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.25
|
| Rate for Payer: United Healthcare All Other HMO |
$765.30
|
| Rate for Payer: United Healthcare HMO Rider |
$748.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.75
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
IP
|
$3,111.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$622.20 |
| Max. Negotiated Rate |
$2,644.35 |
| Rate for Payer: Adventist Health Commercial |
$622.20
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,244.40
|
| Rate for Payer: Galaxy Health WC |
$2,644.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,866.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,075.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,185.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,925.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.64
|
| Rate for Payer: Multiplan Commercial |
$2,488.80
|
| Rate for Payer: Networks By Design Commercial |
$2,022.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,644.35
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$622.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cigna of CA HMO |
$1,991.04
|
| Rate for Payer: Cigna of CA PPO |
$2,302.14
|
| 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 |
$2,644.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,866.60
|
| 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 |
$2,075.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.64
|
| 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 |
$2,488.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,022.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,644.35
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,866.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,555.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,555.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,555.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,555.50
|
| 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 EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
OP
|
$3,437.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.47 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cigna of CA HMO |
$2,199.68
|
| Rate for Payer: Cigna of CA PPO |
$2,543.38
|
| 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 |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| 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 |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| 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 |
$2,749.60
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,718.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,718.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,718.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,718.50
|
| 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 EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
IP
|
$3,437.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$687.40 |
| Max. Negotiated Rate |
$2,921.45 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,374.80
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,127.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| Rate for Payer: Multiplan Commercial |
$2,749.60
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
IP
|
$4,037.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$807.40 |
| Max. Negotiated Rate |
$3,431.45 |
| Rate for Payer: Adventist Health Commercial |
$807.40
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,614.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,614.80
|
| Rate for Payer: Galaxy Health WC |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,538.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,498.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
OP
|
$4,037.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$807.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cigna of CA HMO |
$2,583.68
|
| Rate for Payer: Cigna of CA PPO |
$2,987.38
|
| 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 |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| 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 |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| 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 |
$3,229.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,422.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,018.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,018.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,018.50
|
| 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 EXC BEN LES-HD/HND/FT 3.1-4.CM
|
Facility
|
OP
|
$6,502.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
900501737
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,300.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,925.90
|
| Rate for Payer: Cash Price |
$2,925.90
|
| Rate for Payer: Cash Price |
$2,925.90
|
| Rate for Payer: Cigna of CA HMO |
$4,161.28
|
| Rate for Payer: Cigna of CA PPO |
$4,811.48
|
| 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 |
$5,526.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,901.20
|
| 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 |
$4,336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,560.48
|
| 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 |
$5,201.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,226.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,526.70
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,901.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,251.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,251.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,251.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,251.00
|
| 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 EXC BEN LES-HD/HND/FT 3.1-4.CM
|
Facility
|
IP
|
$6,502.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
900501737
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,300.40 |
| Max. Negotiated Rate |
$5,526.70 |
| Rate for Payer: Adventist Health Commercial |
$1,300.40
|
| Rate for Payer: Cash Price |
$2,925.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,600.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,600.80
|
| Rate for Payer: Galaxy Health WC |
$5,526.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,901.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,477.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,024.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,560.48
|
| Rate for Payer: Multiplan Commercial |
$5,201.60
|
| Rate for Payer: Networks By Design Commercial |
$4,226.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,526.70
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
IP
|
$2,602.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$2,211.70 |
| Rate for Payer: Adventist Health Commercial |
$520.40
|
| Rate for Payer: Cash Price |
$1,170.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,040.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,040.80
|
| Rate for Payer: Galaxy Health WC |
$2,211.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,561.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,735.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$991.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,610.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.48
|
| Rate for Payer: Multiplan Commercial |
$2,081.60
|
| Rate for Payer: Networks By Design Commercial |
$1,691.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,211.70
|
|
