|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$855.10 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$855.10 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cigna of CA HMO |
$643.84
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$503.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$503.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC IDENTIFY SENTINEL NODE
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
|
|
HC IDENTIFY SENTINEL NODE
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$446.72
|
| Rate for Payer: Cigna of CA PPO |
$516.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Multiplan WC |
$813.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Prime Health Services WC |
$805.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC IDENT OF ARTHROPOD
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC IDENT OF ARTHROPOD
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.06
|
| Rate for Payer: Blue Shield of California Commercial |
$10.60
|
| Rate for Payer: Blue Shield of California Commercial |
$115.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.03
|
| Rate for Payer: Blue Shield of California Commercial |
$76.06
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC IDENT OF PARASITES
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC IDENT OF PARASITES
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.06
|
| Rate for Payer: Blue Shield of California Commercial |
$21.21
|
| Rate for Payer: Blue Shield of California Commercial |
$115.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.06
|
| Rate for Payer: Blue Shield of California Commercial |
$76.06
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.11
|
| Rate for Payer: EPIC Health Plan Senior |
$4.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4.74
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna of CA HMO |
$652.80
|
| Rate for Payer: Cigna of CA PPO |
$754.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$647.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.00
|
| Rate for Payer: United Healthcare All Other HMO |
$510.00
|
| Rate for Payer: United Healthcare HMO Rider |
$510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$949.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna of CA HMO |
$652.80
|
| Rate for Payer: Cigna of CA PPO |
$754.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$647.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: EPIC Health Plan Senior |
$408.00
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$647.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.00
|
| Rate for Payer: EPIC Health Plan Senior |
$408.00
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$647.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cigna of CA HMO |
$3,468.16
|
| Rate for Payer: Cigna of CA PPO |
$4,010.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,793.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,709.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$2,221.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$740.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cigna of CA HMO |
$3,468.16
|
| Rate for Payer: Cigna of CA PPO |
$4,010.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,793.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,251.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,083.80 |
| Max. Negotiated Rate |
$4,606.15 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,793.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,167.60
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,197.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$740.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cigna of CA HMO |
$3,468.16
|
| Rate for Payer: Cigna of CA PPO |
$4,010.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,793.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,251.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,083.80 |
| Max. Negotiated Rate |
$4,606.15 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,793.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,167.60
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,197.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Cigna of CA HMO |
$3,468.16
|
| Rate for Payer: Cigna of CA PPO |
$4,010.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,793.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,709.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,709.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,709.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,709.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,083.80 |
| Max. Negotiated Rate |
$4,606.15 |
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,793.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,167.60
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,197.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,419.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,083.80 |
| Max. Negotiated Rate |
$4,606.15 |
| Rate for Payer: Adventist Health Commercial |
$1,083.80
|
| Rate for Payer: Cash Price |
$2,438.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,793.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,167.60
|
| Rate for Payer: Galaxy Health WC |
$4,606.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,251.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,197.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.56
|
| Rate for Payer: Multiplan Commercial |
$4,335.20
|
| Rate for Payer: Networks By Design Commercial |
$3,522.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,606.15
|
|
|
HC I & D LACRIMAL SAC
|
Facility
|
IP
|
$8,647.00
|
|
|
Service Code
|
CPT 68420
|
| Hospital Charge Code |
902890372
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,729.40 |
| Max. Negotiated Rate |
$7,349.95 |
| Rate for Payer: Adventist Health Commercial |
$1,729.40
|
| Rate for Payer: Cash Price |
$3,891.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,052.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,458.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,458.80
|
| Rate for Payer: Galaxy Health WC |
$7,349.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,188.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,490.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.28
|
| Rate for Payer: Multiplan Commercial |
$6,917.60
|
| Rate for Payer: Networks By Design Commercial |
$5,620.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,349.95
|
|
|
HC I & D LACRIMAL SAC
|
Facility
|
OP
|
$8,647.00
|
|
|
Service Code
|
CPT 68420
|
| Hospital Charge Code |
902890372
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$379.87 |
| Max. Negotiated Rate |
$7,349.95 |
| Rate for Payer: Adventist Health Commercial |
$3,545.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,022.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,891.15
|
| Rate for Payer: Cash Price |
$3,891.15
|
| Rate for Payer: Cash Price |
$3,891.15
|
| Rate for Payer: Cigna of CA HMO |
$5,534.08
|
| Rate for Payer: Cigna of CA PPO |
$6,398.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,052.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$7,349.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,188.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,490.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,852.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$6,917.60
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$5,620.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,349.95
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,188.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,188.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC I&D OF MTH LSN;MSTCTR SPACE
|
Facility
|
IP
|
$4,629.00
|
|
|
Service Code
|
CPT 41018
|
| Hospital Charge Code |
900541018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$925.80 |
| Max. Negotiated Rate |
$3,934.65 |
| Rate for Payer: Adventist Health Commercial |
$925.80
|
| Rate for Payer: Cash Price |
$2,083.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,240.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,851.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,851.60
|
| Rate for Payer: Galaxy Health WC |
$3,934.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,777.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,939.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,731.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,110.96
|
| Rate for Payer: Multiplan Commercial |
$3,703.20
|
| Rate for Payer: Networks By Design Commercial |
$3,008.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,934.65
|
|
|
HC I&D OF MTH LSN;MSTCTR SPACE
|
Facility
|
OP
|
$4,629.00
|
|
|
Service Code
|
CPT 41018
|
| Hospital Charge Code |
900541018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.88 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Adventist Health Commercial |
$925.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,083.05
|
| Rate for Payer: Cash Price |
$2,083.05
|
| Rate for Payer: Cash Price |
$2,083.05
|
| Rate for Payer: Cigna of CA HMO |
$2,962.56
|
| Rate for Payer: Cigna of CA PPO |
$3,425.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,240.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$3,934.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,777.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,939.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$582.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,110.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$3,703.20
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,008.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,934.65
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,777.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,314.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,314.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,314.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
