|
HC INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
OP
|
$8,622.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.41 |
| Max. Negotiated Rate |
$7,328.70 |
| Rate for Payer: Adventist Health Commercial |
$1,724.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,879.90
|
| Rate for Payer: Cash Price |
$3,879.90
|
| Rate for Payer: Cash Price |
$3,879.90
|
| Rate for Payer: Cigna of CA HMO |
$5,518.08
|
| Rate for Payer: Cigna of CA PPO |
$6,380.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| 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 |
$6,035.40
|
| 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 |
$7,328.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,173.20
|
| 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 |
$5,474.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,016.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,069.28
|
| 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 |
$6,897.60
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,604.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,328.70
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,173.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,311.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,311.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,311.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,311.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| 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,UPPER ARM/ELBOW
|
Facility
|
OP
|
$8,622.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$308.41 |
| Max. Negotiated Rate |
$7,328.70 |
| Rate for Payer: Adventist Health Commercial |
$3,535.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,373.55
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,879.90
|
| Rate for Payer: Cash Price |
$3,879.90
|
| Rate for Payer: Cash Price |
$3,879.90
|
| Rate for Payer: Cigna of CA HMO |
$5,518.08
|
| Rate for Payer: Cigna of CA PPO |
$6,380.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| 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 |
$6,035.40
|
| 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 |
$7,328.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,173.20
|
| 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 |
$5,474.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,016.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,069.28
|
| 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 |
$6,897.60
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,604.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,328.70
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,173.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,173.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| 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 FINGER TENDON EACH
|
Facility
|
IP
|
$6,753.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,350.60 |
| Max. Negotiated Rate |
$5,740.05 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,727.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,701.20
|
| Rate for Payer: Galaxy Health WC |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,288.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,984.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| Rate for Payer: Multiplan Commercial |
$5,402.40
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
|
|
HC INCISION FINGER TENDON EACH
|
Facility
|
OP
|
$6,753.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Cigna of CA HMO |
$4,321.92
|
| Rate for Payer: Cigna of CA PPO |
$4,997.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,727.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,288.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$5,402.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,051.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,376.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,376.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,376.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,376.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC INCISION LINGUAL FRENUM
|
Facility
|
OP
|
$4,901.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$980.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,205.45
|
| Rate for Payer: Cash Price |
$2,205.45
|
| Rate for Payer: Cash Price |
$2,205.45
|
| Rate for Payer: Cigna of CA HMO |
$3,136.64
|
| Rate for Payer: Cigna of CA PPO |
$3,626.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,430.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$4,165.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,940.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,112.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$3,920.80
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,185.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,165.85
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,940.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,450.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,450.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,450.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,450.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC INCISION LINGUAL FRENUM
|
Facility
|
IP
|
$4,901.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$980.20 |
| Max. Negotiated Rate |
$4,165.85 |
| Rate for Payer: Adventist Health Commercial |
$980.20
|
| Rate for Payer: Cash Price |
$2,205.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,430.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,960.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,960.40
|
| Rate for Payer: Galaxy Health WC |
$4,165.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,940.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,112.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,891.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.24
|
| Rate for Payer: Multiplan Commercial |
$3,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,185.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,165.85
|
|
|
HC INCISION OF EYE
|
Facility
|
IP
|
$6,005.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,201.00 |
| Max. Negotiated Rate |
$5,104.25 |
| Rate for Payer: Adventist Health Commercial |
$1,201.00
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,203.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,402.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,402.00
|
| Rate for Payer: Galaxy Health WC |
$5,104.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,603.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,813.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,542.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.20
|
| Rate for Payer: Multiplan Commercial |
$4,804.00
|
| Rate for Payer: Networks By Design Commercial |
$3,903.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,104.25
|
|
|
HC INCISION OF EYE
|
Facility
|
OP
|
$6,005.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.46 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$1,201.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Cigna of CA HMO |
$3,843.20
|
| Rate for Payer: Cigna of CA PPO |
$4,443.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,203.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$5,104.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,603.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,813.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$4,804.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,903.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,104.25
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,603.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,002.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,002.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,002.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cigna of CA HMO |
$634.88
|
| Rate for Payer: Cigna of CA PPO |
$734.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$694.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$629.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$496.00
|
| Rate for Payer: United Healthcare All Other HMO |
$496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$496.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.40 |
| Max. Negotiated Rate |
$843.20 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$694.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.80
|
| Rate for Payer: EPIC Health Plan Senior |
$396.80
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$629.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$585.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.08
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
|
|
HC INCISION OF URETHRA
|
Facility
|
OP
|
$6,791.00
|
|
|
Service Code
|
CPT 53000
|
| Hospital Charge Code |
902400991
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$259.56 |
| Max. Negotiated Rate |
$5,772.35 |
| Rate for Payer: Adventist Health Commercial |
$1,358.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,130.50
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: Cigna of CA HMO |
$4,346.24
|
| Rate for Payer: Cigna of CA PPO |
$5,025.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$4,753.70
|
| 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 |
$5,772.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,074.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,312.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.84
|
| 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 |
$5,432.80
|
| Rate for Payer: Networks By Design Commercial |
$4,414.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,772.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,074.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,074.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| 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 INCISION OF URETHRA
|
Facility
|
IP
|
$6,791.00
|
|
|
Service Code
|
CPT 53000
|
| Hospital Charge Code |
902400991
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,358.20 |
| Max. Negotiated Rate |
$5,772.35 |
| Rate for Payer: Adventist Health Commercial |
$1,358.20
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,753.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,716.40
|
| Rate for Payer: Galaxy Health WC |
$5,772.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,074.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,312.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,006.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.84
|
| Rate for Payer: Multiplan Commercial |
$5,432.80
|
| Rate for Payer: Networks By Design Commercial |
$4,414.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,772.35
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$320.86 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$683.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cigna of CA HMO |
$1,072.00
|
| Rate for Payer: Cigna of CA PPO |
$1,239.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$320.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,063.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,005.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$686.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$683.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cigna of CA HMO |
$1,072.00
|
| Rate for Payer: Cigna of CA PPO |
$1,239.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,063.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,005.00
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$335.00 |
| Max. Negotiated Rate |
$1,423.75 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.00
|
| Rate for Payer: EPIC Health Plan Senior |
$670.00
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,063.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$988.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$335.00 |
| Max. Negotiated Rate |
$1,423.75 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.00
|
| Rate for Payer: EPIC Health Plan Senior |
$670.00
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,063.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$988.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cigna of CA HMO |
$1,072.00
|
| Rate for Payer: Cigna of CA PPO |
$1,239.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,063.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$837.50
|
| Rate for Payer: United Healthcare All Other HMO |
$837.50
|
| Rate for Payer: United Healthcare HMO Rider |
$837.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$335.00 |
| Max. Negotiated Rate |
$1,423.75 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.00
|
| Rate for Payer: EPIC Health Plan Senior |
$670.00
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,063.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$988.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
|
|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
OP
|
$8,026.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$462.38 |
| Max. Negotiated Rate |
$6,822.10 |
| Rate for Payer: Adventist Health Commercial |
$1,605.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,611.70
|
| Rate for Payer: Cash Price |
$3,611.70
|
| Rate for Payer: Cash Price |
$3,611.70
|
| Rate for Payer: Cigna of CA HMO |
$5,136.64
|
| Rate for Payer: Cigna of CA PPO |
$5,939.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,618.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$6,822.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,815.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,096.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$462.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,926.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$6,420.80
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,216.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,822.10
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,815.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,013.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,013.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,013.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,013.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
IP
|
$8,026.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,605.20 |
| Max. Negotiated Rate |
$6,822.10 |
| Rate for Payer: Adventist Health Commercial |
$1,605.20
|
| Rate for Payer: Cash Price |
$3,611.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,618.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,210.40
|
| Rate for Payer: Galaxy Health WC |
$6,822.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,815.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,096.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,735.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,926.24
|
| Rate for Payer: Multiplan Commercial |
$6,420.80
|
| Rate for Payer: Networks By Design Commercial |
$5,216.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,822.10
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
IP
|
$1,801.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$360.20 |
| Max. Negotiated Rate |
$1,530.85 |
| Rate for Payer: Adventist Health Commercial |
$360.20
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,260.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.40
|
| Rate for Payer: EPIC Health Plan Senior |
$720.40
|
| Rate for Payer: Galaxy Health WC |
$1,530.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,143.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,062.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.24
|
| Rate for Payer: Multiplan Commercial |
$1,440.80
|
| Rate for Payer: Networks By Design Commercial |
$1,170.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.85
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
OP
|
$1,801.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$360.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$576.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Cigna of CA HMO |
$1,152.64
|
| Rate for Payer: Cigna of CA PPO |
$1,332.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,260.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,530.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,143.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,440.80
|
| Rate for Payer: Networks By Design Commercial |
$1,170.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.50
|
| Rate for Payer: United Healthcare All Other HMO |
$900.50
|
| Rate for Payer: United Healthcare HMO Rider |
$900.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$900.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
IP
|
$1,801.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$360.20 |
| Max. Negotiated Rate |
$1,530.85 |
| Rate for Payer: Adventist Health Commercial |
$360.20
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,260.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.40
|
| Rate for Payer: EPIC Health Plan Senior |
$720.40
|
| Rate for Payer: Galaxy Health WC |
$1,530.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,143.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,062.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.24
|
| Rate for Payer: Multiplan Commercial |
$1,440.80
|
| Rate for Payer: Networks By Design Commercial |
$1,170.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.85
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
OP
|
$1,801.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.33 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$360.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Cigna of CA HMO |
$1,152.64
|
| Rate for Payer: Cigna of CA PPO |
$1,332.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,260.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,530.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,143.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,440.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,170.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.85
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.50
|
| Rate for Payer: United Healthcare All Other HMO |
$900.50
|
| Rate for Payer: United Healthcare HMO Rider |
$900.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$900.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.26 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cigna of CA HMO |
$364.16
|
| Rate for Payer: Cigna of CA PPO |
$421.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$112.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$126.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$398.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
