|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
IP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,673.60 |
| Max. Negotiated Rate |
$7,112.80 |
| Rate for Payer: Adventist Health Commercial |
$1,673.60
|
| Rate for Payer: Cash Price |
$4,602.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,347.20
|
| Rate for Payer: Galaxy Health WC |
$7,112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,020.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,581.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,188.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,179.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.32
|
| Rate for Payer: Multiplan Commercial |
$6,694.40
|
| Rate for Payer: Networks By Design Commercial |
$5,439.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,112.80
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
OP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$16,122.00 |
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| 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 |
$118.20
|
| 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 |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| 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
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
IP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,673.60 |
| Max. Negotiated Rate |
$7,112.80 |
| Rate for Payer: Adventist Health Commercial |
$1,673.60
|
| Rate for Payer: Cash Price |
$4,602.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,347.20
|
| Rate for Payer: Galaxy Health WC |
$7,112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,020.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,581.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,188.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,179.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.32
|
| Rate for Payer: Multiplan Commercial |
$6,694.40
|
| Rate for Payer: Networks By Design Commercial |
$5,439.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,112.80
|
|
|
HC INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
OP
|
$8,622.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.41 |
| Max. Negotiated Rate |
$7,328.70 |
| Rate for Payer: Adventist Health Commercial |
$1,724.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$4,742.10
|
| Rate for Payer: Cash Price |
$4,742.10
|
| Rate for Payer: Cash Price |
$4,742.10
|
| Rate for Payer: Cigna of CA HMO |
$5,518.08
|
| Rate for Payer: Cigna of CA PPO |
$6,380.28
|
| 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 |
$7,328.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,173.20
|
| 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 |
$5,750.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,069.28
|
| 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 |
$6,897.60
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,604.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,328.70
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,173.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,311.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,311.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,311.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,311.00
|
| 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
|
|
|
HC INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
IP
|
$8,622.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,724.40 |
| Max. Negotiated Rate |
$7,328.70 |
| Rate for Payer: Adventist Health Commercial |
$1,724.40
|
| Rate for Payer: Cash Price |
$4,742.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,448.80
|
| Rate for Payer: Galaxy Health WC |
$7,328.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,173.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,750.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,284.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,337.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,069.28
|
| Rate for Payer: Multiplan Commercial |
$6,897.60
|
| Rate for Payer: Networks By Design Commercial |
$5,604.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,328.70
|
|
|
HC INCISION FINGER TENDON EACH
|
Facility
|
IP
|
$6,753.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,350.60 |
| Max. Negotiated Rate |
$5,740.05 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Cash Price |
$3,714.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,701.20
|
| Rate for Payer: Galaxy Health WC |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,180.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| Rate for Payer: Multiplan Commercial |
$5,402.40
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
|
|
HC INCISION FINGER TENDON EACH
|
Facility
|
OP
|
$6,753.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,714.15
|
| Rate for Payer: Cash Price |
$3,714.15
|
| Rate for Payer: Cash Price |
$3,714.15
|
| Rate for Payer: Cigna of CA HMO |
$4,321.92
|
| Rate for Payer: Cigna of CA PPO |
$4,997.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$5,402.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,051.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,376.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,376.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,376.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,376.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC INCISION LINGUAL FRENUM
|
Facility
|
OP
|
$4,901.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$980.20
|
| 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 |
$2,695.55
|
| Rate for Payer: Cash Price |
$2,695.55
|
| Rate for Payer: Cash Price |
$2,695.55
|
| Rate for Payer: Cigna of CA HMO |
$3,136.64
|
| Rate for Payer: Cigna of CA PPO |
$3,626.74
|
| 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 |
$4,165.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,940.60
|
| 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 |
$3,268.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.24
|
| 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 |
$3,920.80
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,185.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,165.85
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,940.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,450.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,450.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,450.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,450.50
|
| 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 INCISION LINGUAL FRENUM
|
Facility
|
IP
|
$4,901.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$980.20 |
| Max. Negotiated Rate |
$4,165.85 |
| Rate for Payer: Adventist Health Commercial |
$980.20
|
| Rate for Payer: Cash Price |
$2,695.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,960.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,960.40
|
| Rate for Payer: Galaxy Health WC |
$4,165.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,940.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,268.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,867.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,033.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.24
|
| Rate for Payer: Multiplan Commercial |
$3,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,185.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,165.85
|
|
|
HC INCISION OF EYE
|
Facility
|
OP
|
$6,005.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.46 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,201.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$3,302.75
|
| Rate for Payer: Cash Price |
$3,302.75
|
| Rate for Payer: Cash Price |
$3,302.75
|
| Rate for Payer: Cigna of CA HMO |
$3,843.20
|
| Rate for Payer: Cigna of CA PPO |
$4,443.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$5,104.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,603.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,005.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,804.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,903.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,104.25
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,603.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,002.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,002.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,002.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC INCISION OF EYE
|
Facility
|
IP
|
$6,005.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,201.00 |
| Max. Negotiated Rate |
$5,104.25 |
| Rate for Payer: Adventist Health Commercial |
$1,201.00
|
| Rate for Payer: Cash Price |
$3,302.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,402.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,402.00
|
| Rate for Payer: Galaxy Health WC |
$5,104.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,603.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,005.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,287.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,717.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.20
|
| Rate for Payer: Multiplan Commercial |
$4,804.00
|
| Rate for Payer: Networks By Design Commercial |
$3,903.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,104.25
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.40 |
| Max. Negotiated Rate |
$843.20 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.80
|
| Rate for Payer: EPIC Health Plan Senior |
$396.80
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$614.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.08
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cigna of CA HMO |
$634.88
|
| Rate for Payer: Cigna of CA PPO |
$734.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$496.00
|
| Rate for Payer: United Healthcare All Other HMO |
$496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$496.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC INCISION OF URETHRA
|
Facility
|
IP
|
$6,791.00
|
|
|
Service Code
|
CPT 53000
|
| Hospital Charge Code |
902400991
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,358.20 |
| Max. Negotiated Rate |
$5,772.35 |
| Rate for Payer: Adventist Health Commercial |
$1,358.20
|
| Rate for Payer: Cash Price |
$3,735.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,716.40
|
| Rate for Payer: Galaxy Health WC |
$5,772.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,074.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,587.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,203.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.84
|
| Rate for Payer: Multiplan Commercial |
$5,432.80
|
| Rate for Payer: Networks By Design Commercial |
$4,414.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,772.35
|
|
|
HC INCISION OF URETHRA
|
Facility
|
OP
|
$6,791.00
|
|
|
Service Code
|
CPT 53000
|
| Hospital Charge Code |
902400991
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$259.56 |
| Max. Negotiated Rate |
$5,772.35 |
| Rate for Payer: Adventist Health Commercial |
$1,358.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,735.05
|
| Rate for Payer: Cash Price |
$3,735.05
|
| Rate for Payer: Cash Price |
$3,735.05
|
| Rate for Payer: Cigna of CA HMO |
$4,346.24
|
| Rate for Payer: Cigna of CA PPO |
$5,025.34
|
| 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 |
$5,772.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,074.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.84
|
| 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 |
$5,432.80
|
| Rate for Payer: Networks By Design Commercial |
$4,414.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,772.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,074.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,074.60
|
| 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 |
$2,602.84
|
| 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 INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$335.00 |
| Max. Negotiated Rate |
$1,423.75 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Cash Price |
$921.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.00
|
| Rate for Payer: EPIC Health Plan Senior |
$670.00
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,036.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$921.25
|
| Rate for Payer: Cash Price |
$921.25
|
| Rate for Payer: Cash Price |
$921.25
|
| Rate for Payer: Cigna of CA HMO |
$1,072.00
|
| Rate for Payer: Cigna of CA PPO |
$1,239.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$837.50
|
| Rate for Payer: United Healthcare All Other HMO |
$837.50
|
| Rate for Payer: United Healthcare HMO Rider |
$837.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$335.00 |
| Max. Negotiated Rate |
$1,423.75 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Cash Price |
$921.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.00
|
| Rate for Payer: EPIC Health Plan Senior |
$670.00
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,036.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$921.25
|
| Rate for Payer: Cash Price |
$921.25
|
| Rate for Payer: Cash Price |
$921.25
|
| Rate for Payer: Cigna of CA HMO |
$1,072.00
|
| Rate for Payer: Cigna of CA PPO |
$1,239.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$320.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,005.00
|
| 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 |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
OP
|
$8,026.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.43 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,605.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$4,414.30
|
| Rate for Payer: Cash Price |
$4,414.30
|
| Rate for Payer: Cash Price |
$4,414.30
|
| Rate for Payer: Cigna of CA HMO |
$5,136.64
|
| Rate for Payer: Cigna of CA PPO |
$5,939.24
|
| 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 |
$6,822.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,815.60
|
| 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 |
$5,353.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,926.24
|
| 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 |
$6,420.80
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,216.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,822.10
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,815.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,013.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,013.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,013.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,013.00
|
| 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 INC & REM F/B SUBQ TIS COMPL
|
Facility
|
IP
|
$8,026.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,605.20 |
| Max. Negotiated Rate |
$6,822.10 |
| Rate for Payer: Adventist Health Commercial |
$1,605.20
|
| Rate for Payer: Cash Price |
$4,414.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,210.40
|
| Rate for Payer: Galaxy Health WC |
$6,822.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,815.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,353.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,057.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,968.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,926.24
|
| Rate for Payer: Multiplan Commercial |
$6,420.80
|
| Rate for Payer: Networks By Design Commercial |
$5,216.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,822.10
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
OP
|
$1,801.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.33 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$360.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$990.55
|
| Rate for Payer: Cash Price |
$990.55
|
| Rate for Payer: Cash Price |
$990.55
|
| Rate for Payer: Cigna of CA HMO |
$1,152.64
|
| Rate for Payer: Cigna of CA PPO |
$1,332.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,530.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,201.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,440.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,170.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.85
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.50
|
| Rate for Payer: United Healthcare All Other HMO |
$900.50
|
| Rate for Payer: United Healthcare HMO Rider |
$900.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$900.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
IP
|
$1,801.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$360.20 |
| Max. Negotiated Rate |
$1,530.85 |
| Rate for Payer: Adventist Health Commercial |
$360.20
|
| Rate for Payer: Cash Price |
$990.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.40
|
| Rate for Payer: EPIC Health Plan Senior |
$720.40
|
| Rate for Payer: Galaxy Health WC |
$1,530.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,201.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$686.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,114.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.24
|
| Rate for Payer: Multiplan Commercial |
$1,440.80
|
| Rate for Payer: Networks By Design Commercial |
$1,170.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.85
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$483.65 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.26 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| 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 |
$312.95
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cigna of CA HMO |
$364.16
|
| Rate for Payer: Cigna of CA PPO |
$421.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$112.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$398.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
