|
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
|
456
|
| Min. Negotiated Rate |
$307.57 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Adventist Health Commercial |
$927.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$826.41
|
| 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 |
$1,018.35
|
| 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 |
$1,366.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,584.10
|
| 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 |
$1,923.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.80
|
| 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 |
$1,437.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$307.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.12
|
| 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 |
$1,810.40
|
| 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: TriValley Medical Group Commercial/Senior |
$1,357.80
|
| 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 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$452.60
|
| 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 |
$1,018.35
|
| 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 |
$1,366.17
|
| 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 |
$1,584.10
|
| 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 |
$1,923.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.80
|
| 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 |
$1,437.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$307.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.12
|
| 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 |
$1,810.40
|
| 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 |
$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 1.1-2.0 CM
|
Facility
|
OP
|
$3,430.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$152.08 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,406.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$915.88
|
| 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 |
$1,543.50
|
| Rate for Payer: Cash Price |
$1,543.50
|
| Rate for Payer: Cash Price |
$1,543.50
|
| Rate for Payer: Cigna of CA HMO |
$2,195.20
|
| Rate for Payer: Cigna of CA PPO |
$2,538.20
|
| 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 |
$2,401.00
|
| 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 |
$2,915.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,058.00
|
| 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 |
$2,178.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$823.20
|
| 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 |
$2,744.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,229.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,915.50
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,058.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,058.00
|
| 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 FACIAL LESION 1.1-2.0 CM
|
Facility
|
IP
|
$3,430.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$686.00 |
| Max. Negotiated Rate |
$2,915.50 |
| Rate for Payer: Adventist Health Commercial |
$686.00
|
| Rate for Payer: Cash Price |
$1,543.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,401.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,372.00
|
| Rate for Payer: Galaxy Health WC |
$2,915.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,058.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,178.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,023.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$823.20
|
| Rate for Payer: Multiplan Commercial |
$2,744.00
|
| Rate for Payer: Networks By Design Commercial |
$2,229.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,915.50
|
|
|
HC EXC FACIAL LESION LT 0.5 CM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
902890018
|
|
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 FACIAL LESION LT 0.5 CM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
902890018
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.51
|
| 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 |
$122.38
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| 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 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 |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$192.51
|
| Rate for Payer: Cash Price |
$135.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$645.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$600.03
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$759.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: 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 |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$645.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| 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 |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$645.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$600.03
|
| 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 |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$796.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: 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 |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$645.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| 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 |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC EXCISION, NASAL POLYP(S), SIMPLE
|
Facility
|
OP
|
$4,989.00
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
900501190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.45 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$997.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,245.05
|
| Rate for Payer: Cash Price |
$2,245.05
|
| Rate for Payer: Cash Price |
$2,245.05
|
| Rate for Payer: Cigna of CA HMO |
$3,192.96
|
| Rate for Payer: Cigna of CA PPO |
$3,691.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,492.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$4,240.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,993.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,168.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$3,991.20
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,242.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,240.65
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,993.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,494.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC EXCISION, NASAL POLYP(S), SIMPLE
|
Facility
|
IP
|
$4,989.00
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
900501190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$997.80 |
| Max. Negotiated Rate |
$4,240.65 |
| Rate for Payer: Adventist Health Commercial |
$997.80
|
| Rate for Payer: Cash Price |
$2,245.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,492.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,995.60
|
| Rate for Payer: Galaxy Health WC |
$4,240.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,993.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,168.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,943.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.36
|
| Rate for Payer: Multiplan Commercial |
$3,991.20
|
| Rate for Payer: Networks By Design Commercial |
$3,242.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,240.65
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
OP
|
$7,502.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$7,035.98 |
| Rate for Payer: Adventist Health Commercial |
$3,075.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$842.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,251.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| 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/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,763.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| 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: TriValley Medical Group Commercial/Senior |
$4,501.20
|
| 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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$7,502.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,251.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,763.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,426.18
|
| 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 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 |
$7,035.98 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
| Rate for Payer: Adventist Health Commercial |
$1,500.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,251.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| 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/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,763.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| 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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,251.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,763.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,426.18
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,893.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,717.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,595.95
|
| 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 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$541.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,893.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| 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/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,717.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$981.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| 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 |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,382.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,975.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,693.99
|
| 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/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 |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,252.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| 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 |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,382.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| 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/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,975.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$877.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,502.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,852.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,097.51
|
| 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 |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,583.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,157.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,863.32
|
| 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
|
IP
|
$6,548.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,583.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,157.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,863.32
|
| 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 |
$7,035.98 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,583.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| 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/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,157.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| 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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
