|
HC INACT POLIO ADMINISTRATION
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
908603015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.03
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$977.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$820.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: Cigna of CA HMO |
$1,526.40
|
| Rate for Payer: Cigna of CA PPO |
$1,764.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,669.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,115.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1,410.37
|
| Rate for Payer: Galaxy Health WC |
$2,027.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,102.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,514.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,378.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,615.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,718.08
|
| Rate for Payer: Multiplan Commercial |
$1,908.00
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$1,550.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,027.25
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,431.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,431.00
|
| 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 |
$1,282.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Senior |
$1,410.37
|
| Rate for Payer: Galaxy Health WC |
$2,027.25
|
| Rate for Payer: Adventist Health Commercial |
$477.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: Cigna of CA HMO |
$1,526.40
|
| Rate for Payer: Cigna of CA PPO |
$1,764.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,669.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,115.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,102.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,514.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,378.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,615.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,718.08
|
| Rate for Payer: Multiplan Commercial |
$1,908.00
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$1,550.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,027.25
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,431.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,192.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,192.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,192.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,192.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,282.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$477.00 |
| Max. Negotiated Rate |
$2,027.25 |
| Rate for Payer: Adventist Health Commercial |
$477.00
|
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,669.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.00
|
| Rate for Payer: EPIC Health Plan Senior |
$954.00
|
| Rate for Payer: Galaxy Health WC |
$2,027.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,514.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,407.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| Rate for Payer: Multiplan Commercial |
$1,908.00
|
| Rate for Payer: Networks By Design Commercial |
$1,550.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,027.25
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$477.00 |
| Max. Negotiated Rate |
$2,027.25 |
| Rate for Payer: Adventist Health Commercial |
$477.00
|
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,669.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.00
|
| Rate for Payer: EPIC Health Plan Senior |
$954.00
|
| Rate for Payer: Galaxy Health WC |
$2,027.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,514.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,407.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| Rate for Payer: Multiplan Commercial |
$1,908.00
|
| Rate for Payer: Networks By Design Commercial |
$1,550.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,027.25
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna of CA HMO |
$727.04
|
| Rate for Payer: Cigna of CA PPO |
$840.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$568.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$965.60 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.40
|
| Rate for Payer: EPIC Health Plan Senior |
$454.40
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.64
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
IP
|
$5,915.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,183.00 |
| Max. Negotiated Rate |
$5,027.75 |
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,140.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.00
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,489.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
OP
|
$5,915.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$2,425.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,528.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cigna of CA HMO |
$3,785.60
|
| Rate for Payer: Cigna of CA PPO |
$4,377.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,140.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,837.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,498.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,783.75
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,549.00
|
| 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 |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
IP
|
$5,915.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,183.00 |
| Max. Negotiated Rate |
$5,027.75 |
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,140.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.00
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,489.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
OP
|
$5,915.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cigna of CA HMO |
$3,785.60
|
| Rate for Payer: Cigna of CA PPO |
$4,377.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,140.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,837.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,498.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,783.75
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,957.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,957.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,957.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,957.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,392.20 |
| Max. Negotiated Rate |
$5,916.85 |
| Rate for Payer: Adventist Health Commercial |
$1,392.20
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,872.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,784.40
|
| Rate for Payer: Galaxy Health WC |
$5,916.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,176.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,420.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,106.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.64
|
| Rate for Payer: Multiplan Commercial |
$5,568.80
|
| Rate for Payer: Networks By Design Commercial |
$4,524.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,916.85
|
|
|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$865.83 |
| Max. Negotiated Rate |
$6,943.76 |
| Rate for Payer: United Healthcare HMO Rider |
$3,480.50
|
| Rate for Payer: Adventist Health Commercial |
$1,392.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Cigna of CA HMO |
$4,455.04
|
| Rate for Payer: Cigna of CA PPO |
$5,151.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,872.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$5,916.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,176.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,420.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$865.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$5,568.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,524.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,916.85
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,480.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,480.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,480.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
IP
|
$5,915.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,183.00 |
| Max. Negotiated Rate |
$5,027.75 |
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,140.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.00
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,489.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
IP
|
$5,915.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,183.00 |
| Max. Negotiated Rate |
$5,027.75 |
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,140.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.00
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,489.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
OP
|
$5,915.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$2,425.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,000.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cigna of CA HMO |
$3,785.60
|
| Rate for Payer: Cigna of CA PPO |
$4,377.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,140.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,654.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,549.00
|
| 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 |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
OP
|
$5,915.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,183.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cash Price |
$2,661.75
|
| Rate for Payer: Cigna of CA HMO |
$3,785.60
|
| Rate for Payer: Cigna of CA PPO |
$4,377.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,140.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$5,027.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,654.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$4,732.00
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$3,844.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,027.75
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,957.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,957.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,957.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,957.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
OP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,673.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Cigna of CA HMO |
$5,355.52
|
| Rate for Payer: Cigna of CA PPO |
$6,192.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Galaxy Health WC |
$7,112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,020.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,313.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$6,694.40
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,439.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,112.80
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,020.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,184.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
IP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,673.60 |
| Max. Negotiated Rate |
$7,112.80 |
| Rate for Payer: Adventist Health Commercial |
$1,673.60
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,347.20
|
| Rate for Payer: Galaxy Health WC |
$7,112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,020.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,313.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,937.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.32
|
| Rate for Payer: Multiplan Commercial |
$6,694.40
|
| Rate for Payer: Networks By Design Commercial |
$5,439.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,112.80
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
IP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,673.60 |
| Max. Negotiated Rate |
$7,112.80 |
| Rate for Payer: Adventist Health Commercial |
$1,673.60
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,347.20
|
| Rate for Payer: Galaxy Health WC |
$7,112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,020.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,313.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,937.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.32
|
| Rate for Payer: Multiplan Commercial |
$6,694.40
|
| Rate for Payer: Networks By Design Commercial |
$5,439.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,112.80
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
OP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$133.68 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$3,430.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,168.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Cigna of CA HMO |
$5,355.52
|
| Rate for Payer: Cigna of CA PPO |
$6,192.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Galaxy Health WC |
$7,112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,020.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,313.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,016.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$6,694.40
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,439.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,112.80
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,020.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,020.80
|
| 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 |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
OP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.68 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,673.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Cigna of CA HMO |
$5,355.52
|
| Rate for Payer: Cigna of CA PPO |
$6,192.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Galaxy Health WC |
$7,112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,020.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,313.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,016.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$6,694.40
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,439.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,112.80
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,020.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,184.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,184.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,184.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
IP
|
$8,368.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,673.60 |
| Max. Negotiated Rate |
$7,112.80 |
| Rate for Payer: Adventist Health Commercial |
$1,673.60
|
| Rate for Payer: Cash Price |
$3,765.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,347.20
|
| Rate for Payer: Galaxy Health WC |
$7,112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,020.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,313.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,937.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.32
|
| Rate for Payer: Multiplan Commercial |
$6,694.40
|
| Rate for Payer: Networks By Design Commercial |
$5,439.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,112.80
|
|
|
HC INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
IP
|
$8,622.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,724.40 |
| Max. Negotiated Rate |
$7,328.70 |
| Rate for Payer: Adventist Health Commercial |
$1,724.40
|
| Rate for Payer: Cash Price |
$3,879.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,035.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,448.80
|
| Rate for Payer: Galaxy Health WC |
$7,328.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,173.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,474.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,086.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,069.28
|
| Rate for Payer: Multiplan Commercial |
$6,897.60
|
| Rate for Payer: Networks By Design Commercial |
$5,604.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,328.70
|
|
|
HC INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
IP
|
$8,622.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,724.40 |
| Max. Negotiated Rate |
$7,328.70 |
| Rate for Payer: Adventist Health Commercial |
$1,724.40
|
| Rate for Payer: Cash Price |
$3,879.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,035.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,448.80
|
| Rate for Payer: Galaxy Health WC |
$7,328.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,173.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,474.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,086.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,069.28
|
| Rate for Payer: Multiplan Commercial |
$6,897.60
|
| Rate for Payer: Networks By Design Commercial |
$5,604.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,328.70
|
|
