|
HC I & D COMPL POST-OP WND INF
|
Facility
|
IP
|
$10,575.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
900501007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,115.00 |
| Max. Negotiated Rate |
$8,988.75 |
| Rate for Payer: Adventist Health Commercial |
$2,115.00
|
| Rate for Payer: Cash Price |
$5,816.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,230.00
|
| Rate for Payer: Galaxy Health WC |
$8,988.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,345.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,053.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,029.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,545.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,538.00
|
| Rate for Payer: Multiplan Commercial |
$8,460.00
|
| Rate for Payer: Networks By Design Commercial |
$6,873.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,988.75
|
|
|
HC I & D DEEP ABSCESS NECK/THORAX
|
Facility
|
OP
|
$8,385.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
900501670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,677.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,611.75
|
| Rate for Payer: Cash Price |
$4,611.75
|
| Rate for Payer: Cash Price |
$4,611.75
|
| Rate for Payer: Cigna of CA HMO |
$5,366.40
|
| Rate for Payer: Cigna of CA PPO |
$6,204.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$7,127.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,031.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,592.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,012.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$6,708.00
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,450.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,127.25
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,031.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,192.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,192.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,192.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,192.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC I & D DEEP ABSCESS NECK/THORAX
|
Facility
|
IP
|
$8,385.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
900501670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,677.00 |
| Max. Negotiated Rate |
$7,127.25 |
| Rate for Payer: Adventist Health Commercial |
$1,677.00
|
| Rate for Payer: Cash Price |
$4,611.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,354.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,354.00
|
| Rate for Payer: Galaxy Health WC |
$7,127.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,031.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,592.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,194.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,012.40
|
| Rate for Payer: Multiplan Commercial |
$6,708.00
|
| Rate for Payer: Networks By Design Commercial |
$5,450.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,127.25
|
|
|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cigna of CA HMO |
$643.84
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$503.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$503.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$855.10 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC IDENTIFY SENTINEL NODE
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
|
|
HC IDENTIFY SENTINEL NODE
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Cigna of CA HMO |
$446.72
|
| Rate for Payer: Cigna of CA PPO |
$516.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Multiplan WC |
$813.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Prime Health Services WC |
$805.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC IDENT OF ARTHROPOD
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC IDENT OF ARTHROPOD
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$110.39
|
| Rate for Payer: Blue Shield of California EPN |
$72.93
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC IDENT OF PARASITES
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC IDENT OF PARASITES
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$110.39
|
| Rate for Payer: Blue Shield of California EPN |
$72.93
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$4.31
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna of CA HMO |
$652.80
|
| Rate for Payer: Cigna of CA PPO |
$754.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$680.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.00
|
| Rate for Payer: United Healthcare All Other HMO |
$510.00
|
| Rate for Payer: United Healthcare HMO Rider |
$510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.00
|
| Rate for Payer: EPIC Health Plan Senior |
$408.00
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$680.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$631.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,083.80 |
| Max. Negotiated Rate |
$4,606.15 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,167.60
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,064.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,354.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: Cigna of CA HMO |
$3,468.16
|
| Rate for Payer: Cigna of CA PPO |
$4,010.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,083.80 |
| Max. Negotiated Rate |
$4,606.15 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,167.60
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,064.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,354.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,083.80 |
| Max. Negotiated Rate |
$4,606.15 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,167.60
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,064.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,354.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: Cigna of CA HMO |
$3,468.16
|
| Rate for Payer: Cigna of CA PPO |
$4,010.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,709.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,709.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,709.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,709.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: Cash Price |
$2,980.45
|
| Rate for Payer: Cigna of CA HMO |
$3,468.16
|
| Rate for Payer: Cigna of CA PPO |
$4,010.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,251.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I&D OF MTH LSN;MSTCTR SPACE
|
Facility
|
OP
|
$4,629.00
|
|
|
Service Code
|
CPT 41018
|
| Hospital Charge Code |
900541018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.88 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$925.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,545.95
|
| Rate for Payer: Cash Price |
$2,545.95
|
| Rate for Payer: Cash Price |
$2,545.95
|
| Rate for Payer: Cigna of CA HMO |
$2,962.56
|
| Rate for Payer: Cigna of CA PPO |
$3,425.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$3,934.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,777.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,087.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,110.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$3,703.20
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,008.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,934.65
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,777.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,314.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,314.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,314.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC I&D OF MTH LSN;MSTCTR SPACE
|
Facility
|
IP
|
$4,629.00
|
|
|
Service Code
|
CPT 41018
|
| Hospital Charge Code |
900541018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$925.80 |
| Max. Negotiated Rate |
$3,934.65 |
| Rate for Payer: Adventist Health Commercial |
$925.80
|
| Rate for Payer: Cash Price |
$2,545.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,851.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,851.60
|
| Rate for Payer: Galaxy Health WC |
$3,934.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,777.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,087.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,763.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,865.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,110.96
|
| Rate for Payer: Multiplan Commercial |
$3,703.20
|
| Rate for Payer: Networks By Design Commercial |
$3,008.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,934.65
|
|
|
HC I & D OF SCROTUM
|
Facility
|
IP
|
$8,809.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,761.80 |
| Max. Negotiated Rate |
$7,487.65 |
| Rate for Payer: Adventist Health Commercial |
$1,761.80
|
| Rate for Payer: Cash Price |
$4,844.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,523.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,523.60
|
| Rate for Payer: Galaxy Health WC |
$7,487.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,285.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,875.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,356.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,452.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,114.16
|
| Rate for Payer: Multiplan Commercial |
$7,047.20
|
| Rate for Payer: Networks By Design Commercial |
$5,725.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,487.65
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$8,809.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$377.04 |
| Max. Negotiated Rate |
$7,487.65 |
| Rate for Payer: Adventist Health Commercial |
$1,761.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,844.95
|
| Rate for Payer: Cash Price |
$4,844.95
|
| Rate for Payer: Cash Price |
$4,844.95
|
| Rate for Payer: Cigna of CA HMO |
$5,637.76
|
| Rate for Payer: Cigna of CA PPO |
$6,518.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$7,487.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,285.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,875.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,114.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$7,047.20
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,725.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,487.65
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,285.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,404.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,404.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,404.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,404.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$284.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$782.65
|
| Rate for Payer: Cash Price |
$782.65
|
| Rate for Payer: Cash Price |
$782.65
|
| Rate for Payer: Cigna of CA HMO |
$910.72
|
| Rate for Payer: Cigna of CA PPO |
$1,053.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,209.55
|
| Rate for Payer: Global Benefits Group Commercial |
$853.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$949.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,138.40
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$924.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,209.55
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$711.50
|
| Rate for Payer: United Healthcare All Other HMO |
$711.50
|
| Rate for Payer: United Healthcare HMO Rider |
$711.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.60 |
| Max. Negotiated Rate |
$1,209.55 |
| Rate for Payer: Adventist Health Commercial |
$284.60
|
| Rate for Payer: Cash Price |
$782.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$569.20
|
| Rate for Payer: Galaxy Health WC |
$1,209.55
|
| Rate for Payer: Global Benefits Group Commercial |
$853.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$949.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$880.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.52
|
| Rate for Payer: Multiplan Commercial |
$1,138.40
|
| Rate for Payer: Networks By Design Commercial |
$924.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,209.55
|
|
