|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cigna of CA HMO |
$1,466.50
|
| Rate for Payer: Cigna of CA PPO |
$1,466.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,330.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,236.05
|
| 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 |
$1,361.75
|
| 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
|
IP
|
$3,111.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$622.20 |
| Max. Negotiated Rate |
$2,644.35 |
| Rate for Payer: Adventist Health Commercial |
$622.20
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,177.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,975.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,835.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.64
|
| Rate for Payer: Multiplan Commercial |
$2,488.80
|
| Rate for Payer: Networks By Design Commercial |
$2,022.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,644.35
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$622.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cigna of CA HMO |
$1,991.04
|
| Rate for Payer: Cigna of CA PPO |
$2,302.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,177.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| 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/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,975.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| 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 |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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: Cash Price |
$1,399.95
|
| Rate for Payer: Adventist Health Commercial |
$622.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,177.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,975.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,835.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.64
|
| Rate for Payer: Multiplan Commercial |
$2,488.80
|
| Rate for Payer: Networks By Design Commercial |
$2,022.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,644.35
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Adventist Health Commercial |
$1,275.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$709.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cigna of CA HMO |
$1,991.04
|
| Rate for Payer: Cigna of CA PPO |
$2,302.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,177.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| 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/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,975.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| 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: TriValley Medical Group Commercial/Senior |
$1,866.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cigna of CA HMO |
$2,199.68
|
| Rate for Payer: Cigna of CA PPO |
$2,543.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,405.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| 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/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,182.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| 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 |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
IP
|
$3,437.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$687.40 |
| Max. Negotiated Rate |
$2,921.45 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,405.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,182.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,027.83
|
| 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 GT 4CM
|
Facility
|
OP
|
$7,731.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$3,169.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,479.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cigna of CA HMO |
$4,947.84
|
| Rate for Payer: Cigna of CA PPO |
$5,720.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,411.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,909.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$550.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$6,184.80
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,638.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,638.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC EX BENIGN LES GT 4CM
|
Facility
|
IP
|
$7,731.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,546.20 |
| Max. Negotiated Rate |
$6,571.35 |
| Rate for Payer: Adventist Health Commercial |
$1,546.20
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,411.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,092.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,092.40
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,909.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,561.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.44
|
| Rate for Payer: Multiplan Commercial |
$6,184.80
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
|
|
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
|
456
|
| Min. Negotiated Rate |
$807.40 |
| Max. Negotiated Rate |
$3,431.45 |
| Rate for Payer: Adventist Health Commercial |
$807.40
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,825.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,563.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,381.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
OP
|
$4,037.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$807.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cigna of CA HMO |
$2,583.68
|
| Rate for Payer: Cigna of CA PPO |
$2,987.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,825.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| 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/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,563.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| 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 |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
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
|
456
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,655.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$513.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cigna of CA HMO |
$2,583.68
|
| Rate for Payer: Cigna of CA PPO |
$2,987.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,825.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| 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/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,563.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| 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: TriValley Medical Group Commercial/Senior |
$2,422.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
IP
|
$4,037.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$807.40 |
| Max. Negotiated Rate |
$3,431.45 |
| Rate for Payer: Adventist Health Commercial |
$807.40
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,825.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,563.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,381.83
|
| 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,300.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,925.90
|
| Rate for Payer: Cash Price |
$2,925.90
|
| Rate for Payer: Cash Price |
$2,925.90
|
| Rate for Payer: Cigna of CA HMO |
$4,161.28
|
| Rate for Payer: Cigna of CA PPO |
$4,811.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,551.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| 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/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,128.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,560.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| 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 |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC EXC BEN LES-HD/HND/FT 3.1-4.CM
|
Facility
|
IP
|
$6,502.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
900501737
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,300.40 |
| Max. Negotiated Rate |
$5,526.70 |
| Rate for Payer: Adventist Health Commercial |
$1,300.40
|
| Rate for Payer: Cash Price |
$2,925.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,551.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,128.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,836.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,560.48
|
| Rate for Payer: Multiplan Commercial |
$5,201.60
|
| Rate for Payer: Networks By Design Commercial |
$4,226.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,526.70
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
IP
|
$2,602.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$2,211.70 |
| Rate for Payer: Adventist Health Commercial |
$520.40
|
| Rate for Payer: Cash Price |
$1,170.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,821.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,652.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,535.18
|
| 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$520.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,821.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,652.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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
|
456
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,017.90
|
| Rate for Payer: Adventist Health Commercial |
$973.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$494.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,661.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1,424.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,507.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| 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: TriValley Medical Group Commercial/Senior |
$1,424.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
905501287
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$494.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cigna of CA HMO |
$2,048.00
|
| Rate for Payer: Cigna of CA PPO |
$2,368.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,720.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,920.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,032.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,560.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,080.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,720.00
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,920.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,920.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,661.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,507.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,400.66
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,661.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,507.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,400.66
|
| 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 BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
905501287
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$640.00 |
| Max. Negotiated Rate |
$2,720.00 |
| Rate for Payer: Adventist Health Commercial |
$640.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,280.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,280.00
|
| Rate for Payer: Galaxy Health WC |
$2,720.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,920.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,032.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,888.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.00
|
| Rate for Payer: Multiplan Commercial |
$2,560.00
|
| Rate for Payer: Networks By Design Commercial |
$2,080.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,720.00
|
|
|
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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$474.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,661.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| 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/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,507.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| 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 |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,584.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,437.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,335.17
|
| 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
|
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: Cash Price |
$1,018.35
|
| Rate for Payer: Adventist Health Commercial |
$452.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,584.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,437.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,335.17
|
| 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
|
|
