|
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 |
$1,170.90
|
| Rate for Payer: Cash Price |
$1,170.90
|
| Rate for Payer: Cash Price |
$1,170.90
|
| 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 |
$1,068.30
|
| Rate for Payer: Cash Price |
$1,068.30
|
| Rate for Payer: Cash Price |
$1,068.30
|
| 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 |
$1,068.30
|
| 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 |
$1,018.35
|
| 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 |
$1,018.35
|
| Rate for Payer: Cash Price |
$1,018.35
|
| Rate for Payer: Cash Price |
$1,018.35
|
| 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 |
$135.00
|
| 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 |
$135.00
|
| 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 |
$457.65
|
| 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 |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| 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
|
|
|
HC EXCHG BLD TRANS OTHER THAN NEWBORN
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
906812205
|
|
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 |
$457.65
|
| 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 OTHER THAN NEWBORN
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
906812205
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$194.53 |
| Max. Negotiated Rate |
$7,885.00 |
| 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 |
$7,885.00
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| 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 |
$194.53
|
| 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 |
$220.00
|
| 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
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
OP
|
$7,502.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$6,757.85 |
| Rate for Payer: Adventist Health Commercial |
$1,500.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cigna of CA HMO |
$4,801.28
|
| Rate for Payer: Cigna of CA PPO |
$5,551.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$6,376.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,501.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,003.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$6,001.60
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$4,876.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,376.70
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,751.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,751.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,751.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,751.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$7,502.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,500.40 |
| Max. Negotiated Rate |
$6,376.70 |
| Rate for Payer: Adventist Health Commercial |
$1,500.40
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,000.80
|
| Rate for Payer: Galaxy Health WC |
$6,376.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,501.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,003.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,858.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.48
|
| Rate for Payer: Multiplan Commercial |
$6,001.60
|
| Rate for Payer: Networks By Design Commercial |
$4,876.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,376.70
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
OP
|
$2,705.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$541.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cigna of CA HMO |
$1,731.20
|
| Rate for Payer: Cigna of CA PPO |
$2,001.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,030.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$2,164.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,623.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,352.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,352.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,352.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
IP
|
$2,705.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$2,299.25 |
| Rate for Payer: Adventist Health Commercial |
$541.00
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,030.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,674.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.20
|
| Rate for Payer: Multiplan Commercial |
$2,164.00
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
OP
|
$6,261.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$877.84 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,252.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Cigna of CA HMO |
$4,007.04
|
| Rate for Payer: Cigna of CA PPO |
$4,633.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$5,321.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,756.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$877.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,502.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$5,008.80
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$4,069.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,321.85
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,756.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,130.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,130.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,130.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
IP
|
$6,261.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,252.20 |
| Max. Negotiated Rate |
$5,321.85 |
| Rate for Payer: Adventist Health Commercial |
$1,252.20
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,504.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,504.40
|
| Rate for Payer: Galaxy Health WC |
$5,321.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,756.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,385.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,875.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,502.64
|
| Rate for Payer: Multiplan Commercial |
$5,008.80
|
| Rate for Payer: Networks By Design Commercial |
$4,069.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,321.85
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
IP
|
$6,548.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,309.60 |
| Max. Negotiated Rate |
$5,565.80 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,619.20
|
| Rate for Payer: Galaxy Health WC |
$5,565.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,928.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,494.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,053.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| Rate for Payer: Multiplan Commercial |
$5,238.40
|
| Rate for Payer: Networks By Design Commercial |
$4,256.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,565.80
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
OP
|
$6,548.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$6,757.85 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cigna of CA HMO |
$4,190.72
|
| Rate for Payer: Cigna of CA PPO |
$4,845.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$5,565.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,928.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$5,238.40
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$4,256.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,565.80
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,928.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,274.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
OP
|
$7,270.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$6,179.50 |
| Rate for Payer: Adventist Health Commercial |
$1,454.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,271.50
|
| Rate for Payer: Cash Price |
$3,271.50
|
| Rate for Payer: Cash Price |
$3,271.50
|
| Rate for Payer: Cigna of CA HMO |
$4,652.80
|
| Rate for Payer: Cigna of CA PPO |
$5,379.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$6,179.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,362.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,849.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,744.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$5,816.00
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$4,725.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,179.50
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,362.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,635.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,635.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,635.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
IP
|
$7,270.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,454.00 |
| Max. Negotiated Rate |
$6,179.50 |
| Rate for Payer: Adventist Health Commercial |
$1,454.00
|
| Rate for Payer: Cash Price |
$3,271.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,908.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,908.00
|
| Rate for Payer: Galaxy Health WC |
$6,179.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,849.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,769.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,500.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,744.80
|
| Rate for Payer: Multiplan Commercial |
$5,816.00
|
| Rate for Payer: Networks By Design Commercial |
$4,725.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,179.50
|
|
|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$135.15 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Senior |
$63.60
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.16
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
|
|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.64
|
| Rate for Payer: Blue Shield of California Commercial |
$97.31
|
| Rate for Payer: Blue Shield of California EPN |
$64.24
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cigna of CA HMO |
$101.76
|
| Rate for Payer: Cigna of CA PPO |
$117.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$198.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.07
|
| Rate for Payer: Blue Shield of California Commercial |
$185.44
|
| Rate for Payer: Blue Shield of California EPN |
$122.41
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cigna of CA HMO |
$193.92
|
| Rate for Payer: Cigna of CA PPO |
$224.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$257.55 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
|
