|
HC IMPL STJ DUCT II OCCL DEVICE
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$9,350.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,050.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,371.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,118.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,346.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,350.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,700.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,700.00
|
| Rate for Payer: Multiplan Commercial |
$8,800.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,350.00
|
|
|
HC IMPL STJ DUCT II OCCL DEVICE
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.00
|
| Rate for Payer: Multiplan Commercial |
$8,800.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$4,708.99 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,107.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,708.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,033.06
|
| Rate for Payer: Blue Shield of California EPN |
$681.95
|
| Rate for Payer: Cash Price |
$928.40
|
| Rate for Payer: Cash Price |
$928.40
|
| Rate for Payer: Cash Price |
$928.40
|
| Rate for Payer: Cigna of CA HMO |
$1,080.32
|
| Rate for Payer: Cigna of CA PPO |
$1,249.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,012.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$1,434.80 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Cash Price |
$928.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Senior |
$675.20
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,044.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.12
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$1,603.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$320.60 |
| Max. Negotiated Rate |
$1,362.55 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.20
|
| Rate for Payer: EPIC Health Plan Senior |
$641.20
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$992.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,282.40
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$1,603.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$320.60 |
| Max. Negotiated Rate |
$3,923.39 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,051.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,923.39
|
| Rate for Payer: Blue Shield of California Commercial |
$981.04
|
| Rate for Payer: Blue Shield of California EPN |
$647.61
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: Cigna of CA HMO |
$1,025.92
|
| Rate for Payer: Cigna of CA PPO |
$1,186.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$1,282.40
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
|
OP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,914.61 |
| Max. Negotiated Rate |
$16,230.75 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,393.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,106.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,106.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,726.24
|
| Rate for Payer: Cash Price |
$10,502.25
|
| Rate for Payer: Cash Price |
$10,502.25
|
| Rate for Payer: Cigna of CA HMO |
$13,366.50
|
| Rate for Payer: Cigna of CA PPO |
$13,366.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,393.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,106.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,106.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,584.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1,914.61
|
| Rate for Payer: Galaxy Health WC |
$16,230.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,457.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,139.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,914.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,736.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,914.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,582.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,412.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,565.58
|
| Rate for Payer: Multiplan Commercial |
$15,276.00
|
| Rate for Payer: Networks By Design Commercial |
$9,547.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,230.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,457.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,457.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,166.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6,975.40
|
| Rate for Payer: United Healthcare HMO Rider |
$6,824.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,253.61
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,914.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,393.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,106.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,106.07
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
|
IP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,819.00 |
| Max. Negotiated Rate |
$16,230.75 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,092.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,280.17
|
| Rate for Payer: Cash Price |
$10,502.25
|
| Rate for Payer: Cigna of CA HMO |
$13,366.50
|
| Rate for Payer: Cigna of CA PPO |
$13,366.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,638.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,638.00
|
| Rate for Payer: Galaxy Health WC |
$16,230.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,736.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,275.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,819.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,582.80
|
| Rate for Payer: Multiplan Commercial |
$15,276.00
|
| Rate for Payer: Networks By Design Commercial |
$9,547.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,230.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,166.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6,975.40
|
| Rate for Payer: United Healthcare HMO Rider |
$6,824.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,253.61
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
|
IP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,693.80 |
| Max. Negotiated Rate |
$7,198.65 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,250.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,115.93
|
| Rate for Payer: Cash Price |
$4,657.95
|
| Rate for Payer: Cigna of CA HMO |
$5,928.30
|
| Rate for Payer: Cigna of CA PPO |
$5,928.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,387.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,387.60
|
| Rate for Payer: Galaxy Health WC |
$7,198.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,081.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,648.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,226.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,242.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,032.56
|
| Rate for Payer: Multiplan Commercial |
$6,775.20
|
| Rate for Payer: Networks By Design Commercial |
$4,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,198.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,178.42
|
| Rate for Payer: United Healthcare All Other HMO |
$3,093.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3,026.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,773.60
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
|
OP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,693.80 |
| Max. Negotiated Rate |
$7,198.65 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,198.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,657.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,351.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,200.81
|
| Rate for Payer: Cash Price |
$4,657.95
|
| Rate for Payer: Cash Price |
$4,657.95
|
| Rate for Payer: Cigna of CA HMO |
$5,928.30
|
| Rate for Payer: Cigna of CA PPO |
$5,928.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,198.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,198.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,198.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,387.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,387.60
|
| Rate for Payer: Galaxy Health WC |
$7,198.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,081.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,783.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,648.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,279.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,242.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,032.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,928.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,928.30
|
| Rate for Payer: Multiplan Commercial |
$6,775.20
|
| Rate for Payer: Networks By Design Commercial |
$4,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,198.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,081.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,081.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,178.42
|
| Rate for Payer: United Healthcare All Other HMO |
$3,093.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3,026.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,773.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,198.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,198.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,198.65
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
IP
|
$14,213.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,842.60 |
| Max. Negotiated Rate |
$12,081.05 |
| Rate for Payer: Adventist Health Commercial |
$2,842.60
|
| Rate for Payer: Cash Price |
$7,817.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,685.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,685.20
|
| Rate for Payer: Galaxy Health WC |
$12,081.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,527.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,415.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,797.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,411.12
|
| Rate for Payer: Multiplan Commercial |
$11,370.40
|
| Rate for Payer: Networks By Design Commercial |
$9,238.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,081.05
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
OP
|
$14,213.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$798.02 |
| Max. Negotiated Rate |
$12,081.05 |
| Rate for Payer: Adventist Health Commercial |
$2,842.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$877.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,728.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,698.36
|
| Rate for Payer: Blue Shield of California EPN |
$5,742.05
|
| Rate for Payer: Cash Price |
$7,817.15
|
| Rate for Payer: Cash Price |
$7,817.15
|
| Rate for Payer: Cigna of CA HMO |
$9,096.32
|
| Rate for Payer: Cigna of CA PPO |
$10,517.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$877.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$877.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.33
|
| Rate for Payer: EPIC Health Plan Senior |
$798.02
|
| Rate for Payer: Galaxy Health WC |
$12,081.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,527.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,308.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,863.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$798.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,631.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$798.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,411.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,005.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,069.35
|
| Rate for Payer: Multiplan Commercial |
$11,370.40
|
| Rate for Payer: Networks By Design Commercial |
$9,238.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,081.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,527.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,527.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,106.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,106.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,106.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,106.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$798.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$877.82
|
| Rate for Payer: Vantage Medical Group Senior |
$877.82
|
|
|
HC INACT POLIO ADMINISTRATION
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
908603015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC INACT POLIO ADMINISTRATION
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
908603015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.95
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$477.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,311.75
|
| Rate for Payer: Cash Price |
$1,311.75
|
| Rate for Payer: Cash Price |
$1,311.75
|
| Rate for Payer: Cigna of CA HMO |
$1,526.40
|
| Rate for Payer: Cigna of CA PPO |
$1,764.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,353.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,230.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,230.63
|
| Rate for Payer: Galaxy Health WC |
$2,027.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,018.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,230.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,590.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,550.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,649.04
|
| Rate for Payer: Multiplan Commercial |
$1,908.00
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$1,550.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,027.25
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,431.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,192.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,192.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,192.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,192.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,230.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,230.63
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$477.00 |
| Max. Negotiated Rate |
$2,027.25 |
| Rate for Payer: Adventist Health Commercial |
$477.00
|
| Rate for Payer: Cash Price |
$1,311.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.00
|
| Rate for Payer: EPIC Health Plan Senior |
$954.00
|
| Rate for Payer: Galaxy Health WC |
$2,027.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,590.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$908.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,476.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| Rate for Payer: Multiplan Commercial |
$1,908.00
|
| Rate for Payer: Networks By Design Commercial |
$1,550.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,027.25
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$965.60 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.40
|
| Rate for Payer: EPIC Health Plan Senior |
$454.40
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$703.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.64
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cigna of CA HMO |
$727.04
|
| Rate for Payer: Cigna of CA PPO |
$840.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
IP
|
$5,915.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,183.00 |
| Max. Negotiated Rate |
$5,027.75 |
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.00
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,253.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,661.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
OP
|
$5,915.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: Cigna of CA HMO |
$3,785.60
|
| Rate for Payer: Cigna of CA PPO |
$4,377.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,704.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.48
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,714.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,669.20
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,957.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,957.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,957.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,957.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,484.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,392.20 |
| Max. Negotiated Rate |
$5,916.85 |
| Rate for Payer: Adventist Health Commercial |
$1,392.20
|
| Rate for Payer: Cash Price |
$3,828.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,784.40
|
| Rate for Payer: Galaxy Health WC |
$5,916.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,176.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,652.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,308.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.64
|
| Rate for Payer: Multiplan Commercial |
$5,568.80
|
| Rate for Payer: Networks By Design Commercial |
$4,524.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,916.85
|
|
|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$865.83 |
| Max. Negotiated Rate |
$6,761.06 |
| Rate for Payer: Adventist Health Commercial |
$1,392.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,828.55
|
| Rate for Payer: Cash Price |
$3,828.55
|
| Rate for Payer: Cash Price |
$3,828.55
|
| Rate for Payer: Cigna of CA HMO |
$4,455.04
|
| Rate for Payer: Cigna of CA PPO |
$5,151.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$5,916.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,176.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$865.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$5,568.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,524.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,916.85
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,480.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,480.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,480.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,480.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
IP
|
$5,915.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,183.00 |
| Max. Negotiated Rate |
$5,027.75 |
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.00
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,253.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,661.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
OP
|
$5,915.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: Cigna of CA HMO |
$3,785.60
|
| Rate for Payer: Cigna of CA PPO |
$4,377.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,957.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,957.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,957.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,957.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
OP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.68 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,673.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$7,885.00
|
| Rate for Payer: Cash Price |
$4,602.40
|
| Rate for Payer: Cash Price |
$4,602.40
|
| Rate for Payer: Cash Price |
$4,602.40
|
| Rate for Payer: Cigna of CA HMO |
$5,355.52
|
| Rate for Payer: Cigna of CA PPO |
$6,192.32
|
| 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 |
$7,112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,020.80
|
| 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 |
$5,581.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.32
|
| 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 |
$6,694.40
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,439.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,112.80
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,020.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,184.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,184.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,184.00
|
| 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
|
|
