|
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 |
$1,053.25
|
| Rate for Payer: Cash Price |
$1,053.25
|
| 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 |
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 |
$1,053.25
|
| Rate for Payer: Cash Price |
$1,053.25
|
| 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 |
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 |
$1,053.25
|
| Rate for Payer: Cash Price |
$1,053.25
|
| 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
|
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 |
$1,113.75
|
| Rate for Payer: Cash Price |
$1,113.75
|
| 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
|
$2,025.00
|
|
|
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 |
$1,113.75
|
| Rate for Payer: Cash Price |
$1,113.75
|
| 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
|
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 |
$1,152.25
|
| Rate for Payer: Cash Price |
$1,152.25
|
| 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 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 |
$1,152.25
|
| Rate for Payer: Cash Price |
$1,152.25
|
| 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 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 |
$1,711.05
|
| Rate for Payer: Cash Price |
$1,711.05
|
| Rate for Payer: Cash Price |
$1,711.05
|
| 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 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 |
$1,711.05
|
| 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 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 |
$1,890.35
|
| Rate for Payer: Cash Price |
$1,890.35
|
| Rate for Payer: Cash Price |
$1,890.35
|
| 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 |
$1,890.35
|
| 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
|
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 |
$2,220.35
|
| Rate for Payer: Cash Price |
$2,220.35
|
| Rate for Payer: Cash Price |
$2,220.35
|
| 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 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 |
$2,220.35
|
| 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 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 |
$3,576.10
|
| Rate for Payer: Cash Price |
$3,576.10
|
| Rate for Payer: Cash Price |
$3,576.10
|
| 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 |
$3,576.10
|
| 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 |
$1,431.10
|
| 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
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
OP
|
$2,602.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.45 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$520.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,431.10
|
| Rate for Payer: Cash Price |
$1,431.10
|
| Rate for Payer: Cash Price |
$1,431.10
|
| Rate for Payer: Cigna of CA HMO |
$1,665.28
|
| Rate for Payer: Cigna of CA PPO |
$1,925.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,211.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,561.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,735.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,081.60
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,691.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,211.70
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,561.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,301.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,301.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,301.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,301.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$2,374.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$474.80
|
| 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 |
$1,305.70
|
| Rate for Payer: Cash Price |
$1,305.70
|
| Rate for Payer: Cash Price |
$1,305.70
|
| Rate for Payer: Cigna of CA HMO |
$1,519.36
|
| Rate for Payer: Cigna of CA PPO |
$1,756.76
|
| 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 |
$2,017.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,424.40
|
| 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 |
$1,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,899.20
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,543.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,017.90
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,424.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,187.00
|
| 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 EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$2,374.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$474.80 |
| Max. Negotiated Rate |
$2,017.90 |
| Rate for Payer: Adventist Health Commercial |
$474.80
|
| Rate for Payer: Cash Price |
$1,305.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$949.60
|
| Rate for Payer: EPIC Health Plan Senior |
$949.60
|
| Rate for Payer: Galaxy Health WC |
$2,017.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,424.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,469.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.76
|
| Rate for Payer: Multiplan Commercial |
$1,899.20
|
| Rate for Payer: Networks By Design Commercial |
$1,543.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,017.90
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$452.60 |
| Max. Negotiated Rate |
$1,923.55 |
| Rate for Payer: Adventist Health Commercial |
$452.60
|
| Rate for Payer: Cash Price |
$1,244.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$905.20
|
| Rate for Payer: EPIC Health Plan Senior |
$905.20
|
| Rate for Payer: Galaxy Health WC |
$1,923.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,509.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$862.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.12
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: Networks By Design Commercial |
$1,470.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,923.55
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$307.57 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$452.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$1,244.65
|
| Rate for Payer: Cash Price |
$1,244.65
|
| Rate for Payer: Cash Price |
$1,244.65
|
| Rate for Payer: Cigna of CA HMO |
$1,448.32
|
| Rate for Payer: Cigna of CA PPO |
$1,674.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,923.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.80
|
| 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 |
$1,509.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,470.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,923.55
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,357.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,131.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,131.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,131.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.50
|
| 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 EXCHANGE STEERABLE GW
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.23
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC EXCHANGE STEERABLE GW
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC EXCHG BLD TRANS NEWBORN
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 36450
|
| Hospital Charge Code |
906812206
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$406.80
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$629.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
|
|
HC EXCHG BLD TRANS NEWBORN
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 36450
|
| Hospital Charge Code |
906812206
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cigna of CA HMO |
$650.88
|
| Rate for Payer: Cigna of CA PPO |
$752.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$610.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
