|
HC I & D OF SCROTUM
|
Facility
|
IP
|
$8,809.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,761.80 |
| Max. Negotiated Rate |
$7,487.65 |
| Rate for Payer: Adventist Health Commercial |
$1,761.80
|
| Rate for Payer: Cash Price |
$3,964.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,166.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,523.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,523.60
|
| Rate for Payer: Galaxy Health WC |
$7,487.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,285.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,593.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,197.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,114.16
|
| Rate for Payer: Multiplan Commercial |
$7,047.20
|
| Rate for Payer: Networks By Design Commercial |
$5,725.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,487.65
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$8,809.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$377.04 |
| Max. Negotiated Rate |
$7,487.65 |
| Rate for Payer: Adventist Health Commercial |
$3,611.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,519.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,964.05
|
| Rate for Payer: Cash Price |
$3,964.05
|
| Rate for Payer: Cash Price |
$3,964.05
|
| Rate for Payer: Cigna of CA HMO |
$5,637.76
|
| Rate for Payer: Cigna of CA PPO |
$6,518.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,166.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$7,487.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,285.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,593.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$377.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,114.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$7,047.20
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,725.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,487.65
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,285.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,285.40
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC I & D OF SCROTUM
|
Facility
|
IP
|
$8,809.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,761.80 |
| Max. Negotiated Rate |
$7,487.65 |
| Rate for Payer: Adventist Health Commercial |
$1,761.80
|
| Rate for Payer: Cash Price |
$3,964.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,166.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,523.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,523.60
|
| Rate for Payer: Galaxy Health WC |
$7,487.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,285.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,593.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,197.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,114.16
|
| Rate for Payer: Multiplan Commercial |
$7,047.20
|
| Rate for Payer: Networks By Design Commercial |
$5,725.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,487.65
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$8,809.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$377.04 |
| Max. Negotiated Rate |
$7,487.65 |
| Rate for Payer: Adventist Health Commercial |
$1,761.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,964.05
|
| Rate for Payer: Cash Price |
$3,964.05
|
| Rate for Payer: Cash Price |
$3,964.05
|
| Rate for Payer: Cigna of CA HMO |
$5,637.76
|
| Rate for Payer: Cigna of CA PPO |
$6,518.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,166.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$7,487.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,285.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,593.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$377.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,114.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$7,047.20
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,725.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,487.65
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,285.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,404.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,404.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,404.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,404.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$284.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$640.35
|
| Rate for Payer: Cash Price |
$640.35
|
| Rate for Payer: Cash Price |
$640.35
|
| Rate for Payer: Cigna of CA HMO |
$910.72
|
| Rate for Payer: Cigna of CA PPO |
$1,053.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$996.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$1,209.55
|
| Rate for Payer: Global Benefits Group Commercial |
$853.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$903.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$172.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$1,138.40
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$924.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,209.55
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$711.50
|
| Rate for Payer: United Healthcare All Other HMO |
$711.50
|
| Rate for Payer: United Healthcare HMO Rider |
$711.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.60 |
| Max. Negotiated Rate |
$1,209.55 |
| Rate for Payer: Adventist Health Commercial |
$284.60
|
| Rate for Payer: Cash Price |
$640.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$996.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$569.20
|
| Rate for Payer: Galaxy Health WC |
$1,209.55
|
| Rate for Payer: Global Benefits Group Commercial |
$853.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$903.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$839.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.52
|
| Rate for Payer: Multiplan Commercial |
$1,138.40
|
| Rate for Payer: Networks By Design Commercial |
$924.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,209.55
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$284.60 |
| Max. Negotiated Rate |
$1,209.55 |
| Rate for Payer: Adventist Health Commercial |
$284.60
|
| Rate for Payer: Cash Price |
$640.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$996.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$569.20
|
| Rate for Payer: Galaxy Health WC |
$1,209.55
|
| Rate for Payer: Global Benefits Group Commercial |
$853.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$903.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$839.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.52
|
| Rate for Payer: Multiplan Commercial |
$1,138.40
|
| Rate for Payer: Networks By Design Commercial |
$924.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,209.55
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$583.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$769.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$640.35
|
| Rate for Payer: Cash Price |
$640.35
|
| Rate for Payer: Cash Price |
$640.35
|
| Rate for Payer: Cigna of CA HMO |
$910.72
|
| Rate for Payer: Cigna of CA PPO |
$1,053.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$996.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$1,209.55
|
| Rate for Payer: Global Benefits Group Commercial |
$853.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$903.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$172.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$1,138.40
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$924.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,209.55
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$853.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.54
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Blue Shield of California Commercial |
$116.89
|
| Rate for Payer: Blue Shield of California Commercial |
$77.06
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
OP
|
$2,406.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$151.37 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$986.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$611.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Cigna of CA HMO |
$1,539.84
|
| Rate for Payer: Cigna of CA PPO |
$1,780.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,684.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: Galaxy Health WC |
$2,045.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,443.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,527.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,507.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$1,924.80
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$1,563.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,045.10
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,443.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,443.60
|
| 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 |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
OP
|
$2,406.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.37 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Cigna of CA HMO |
$1,539.84
|
| Rate for Payer: Cigna of CA PPO |
$1,780.44
|
| Rate for Payer: Adventist Health Commercial |
$481.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,684.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: Galaxy Health WC |
$2,045.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,443.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,527.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,507.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$1,924.80
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$1,563.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,045.10
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,443.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,203.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
IP
|
$2,406.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.20 |
| Max. Negotiated Rate |
$2,045.10 |
| Rate for Payer: Adventist Health Commercial |
$481.20
|
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,684.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$962.40
|
| Rate for Payer: EPIC Health Plan Senior |
$962.40
|
| Rate for Payer: Galaxy Health WC |
$2,045.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,443.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,527.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,419.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.44
|
| Rate for Payer: Multiplan Commercial |
$1,924.80
|
| Rate for Payer: Networks By Design Commercial |
$1,563.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,045.10
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
IP
|
$2,406.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$481.20 |
| Max. Negotiated Rate |
$2,045.10 |
| Rate for Payer: Adventist Health Commercial |
$481.20
|
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,684.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$962.40
|
| Rate for Payer: EPIC Health Plan Senior |
$962.40
|
| Rate for Payer: Galaxy Health WC |
$2,045.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,443.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,527.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,419.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.44
|
| Rate for Payer: Multiplan Commercial |
$1,924.80
|
| Rate for Payer: Networks By Design Commercial |
$1,563.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,045.10
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
OP
|
$1,148.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna of CA HMO |
$734.72
|
| Rate for Payer: Cigna of CA PPO |
$849.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$803.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$975.80
|
| Rate for Payer: Global Benefits Group Commercial |
$688.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$728.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$975.80
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$688.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.00
|
| Rate for Payer: United Healthcare All Other HMO |
$574.00
|
| Rate for Payer: United Healthcare HMO Rider |
$574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$574.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
OP
|
$1,148.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$470.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$924.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna of CA HMO |
$734.72
|
| Rate for Payer: Cigna of CA PPO |
$849.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$803.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$975.80
|
| Rate for Payer: Global Benefits Group Commercial |
$688.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$728.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$975.80
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$688.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$688.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
IP
|
$1,148.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$975.80 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$803.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.20
|
| Rate for Payer: EPIC Health Plan Senior |
$459.20
|
| Rate for Payer: Galaxy Health WC |
$975.80
|
| Rate for Payer: Global Benefits Group Commercial |
$688.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$728.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$677.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.52
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: Networks By Design Commercial |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$975.80
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
IP
|
$1,148.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$975.80 |
| Rate for Payer: EPIC Health Plan Commercial |
$459.20
|
| Rate for Payer: EPIC Health Plan Senior |
$459.20
|
| Rate for Payer: Galaxy Health WC |
$975.80
|
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$803.60
|
| Rate for Payer: Global Benefits Group Commercial |
$688.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$728.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$677.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.52
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: Networks By Design Commercial |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$975.80
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
IP
|
$4,371.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$874.20 |
| Max. Negotiated Rate |
$3,715.35 |
| Rate for Payer: Adventist Health Commercial |
$874.20
|
| Rate for Payer: Cash Price |
$1,966.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,059.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.40
|
| Rate for Payer: Galaxy Health WC |
$3,715.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,775.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,578.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.04
|
| Rate for Payer: Multiplan Commercial |
$3,496.80
|
| Rate for Payer: Networks By Design Commercial |
$2,841.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,715.35
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
OP
|
$4,371.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,792.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,044.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,966.95
|
| Rate for Payer: Cash Price |
$1,966.95
|
| Rate for Payer: Cash Price |
$1,966.95
|
| Rate for Payer: Cigna of CA HMO |
$2,797.44
|
| Rate for Payer: Cigna of CA PPO |
$3,234.54
|
| 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 |
$3,059.70
|
| 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 |
$3,715.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,775.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$608.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.04
|
| 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 |
$3,496.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,841.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,715.35
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,622.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,622.60
|
| 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 PILONIDAL CYST COMPLICAT
|
Facility
|
IP
|
$4,371.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$874.20 |
| Max. Negotiated Rate |
$3,715.35 |
| Rate for Payer: Adventist Health Commercial |
$874.20
|
| Rate for Payer: Cash Price |
$1,966.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,059.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.40
|
| Rate for Payer: Galaxy Health WC |
$3,715.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,775.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,578.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.04
|
| Rate for Payer: Multiplan Commercial |
$3,496.80
|
| Rate for Payer: Networks By Design Commercial |
$2,841.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,715.35
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
OP
|
$4,371.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$608.59 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$874.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,966.95
|
| Rate for Payer: Cash Price |
$1,966.95
|
| Rate for Payer: Cash Price |
$1,966.95
|
| Rate for Payer: Cigna of CA HMO |
$2,797.44
|
| Rate for Payer: Cigna of CA PPO |
$3,234.54
|
| 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 |
$3,059.70
|
| 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 |
$3,715.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,775.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$608.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.04
|
| 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 |
$3,496.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,841.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,715.35
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,622.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,185.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,185.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,185.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,185.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$910.35 |
| Rate for Payer: Adventist Health Commercial |
$214.20
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$749.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$428.40
|
| Rate for Payer: Galaxy Health WC |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$680.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$631.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.04
|
| Rate for Payer: Multiplan Commercial |
$856.80
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
| Rate for Payer: Adventist Health Commercial |
$214.20
|
| 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 |
$481.95
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Cigna of CA HMO |
$685.44
|
| Rate for Payer: Cigna of CA PPO |
$792.54
|
| 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 |
$749.70
|
| 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 |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| 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 |
$680.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.04
|
| 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 |
$856.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$642.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO |
$535.50
|
| Rate for Payer: United Healthcare HMO Rider |
$535.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$535.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$439.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$626.05
|
| 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 |
$481.95
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Cigna of CA HMO |
$685.44
|
| Rate for Payer: Cigna of CA PPO |
$792.54
|
| 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 |
$749.70
|
| 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 |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| 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 |
$680.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.04
|
| 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 |
$856.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$642.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$642.60
|
| 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
|
|
