|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,841.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947200113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$768.20 |
| Max. Negotiated Rate |
$3,264.85 |
| Rate for Payer: Adventist Health Commercial |
$768.20
|
| Rate for Payer: Cash Price |
$1,728.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,536.40
|
| Rate for Payer: Galaxy Health WC |
$3,264.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,561.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.84
|
| Rate for Payer: Multiplan Commercial |
$3,072.80
|
| Rate for Payer: Networks By Design Commercial |
$2,496.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,264.85
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,841.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
940100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$768.20 |
| Max. Negotiated Rate |
$3,264.85 |
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.40
|
| Rate for Payer: Adventist Health Commercial |
$768.20
|
| Rate for Payer: Cash Price |
$1,728.45
|
| Rate for Payer: EPIC Health Plan Senior |
$1,536.40
|
| Rate for Payer: Galaxy Health WC |
$3,264.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,561.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.84
|
| Rate for Payer: Multiplan Commercial |
$3,072.80
|
| Rate for Payer: Networks By Design Commercial |
$2,496.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,264.85
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,841.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947300113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$768.20 |
| Max. Negotiated Rate |
$3,264.85 |
| Rate for Payer: Adventist Health Commercial |
$768.20
|
| Rate for Payer: Cash Price |
$1,728.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,536.40
|
| Rate for Payer: Galaxy Health WC |
$3,264.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,561.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.84
|
| Rate for Payer: Multiplan Commercial |
$3,072.80
|
| Rate for Payer: Networks By Design Commercial |
$2,496.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,264.85
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.27 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,587.52
|
| Rate for Payer: Cigna of CA PPO |
$2,991.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
IP
|
$6,771.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,354.20 |
| Max. Negotiated Rate |
$5,755.35 |
| Rate for Payer: Adventist Health Commercial |
$1,354.20
|
| Rate for Payer: Cash Price |
$3,046.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,708.40
|
| Rate for Payer: Galaxy Health WC |
$5,755.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,579.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,191.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.04
|
| Rate for Payer: Multiplan Commercial |
$5,416.80
|
| Rate for Payer: Networks By Design Commercial |
$4,401.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,755.35
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
OP
|
$6,771.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.37 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,187.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,270.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,791.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,046.95
|
| Rate for Payer: Cash Price |
$3,046.95
|
| Rate for Payer: Cash Price |
$3,046.95
|
| Rate for Payer: Cigna of CA HMO |
$4,333.44
|
| Rate for Payer: Cigna of CA PPO |
$5,010.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,187.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,270.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,791.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,468.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,791.43
|
| Rate for Payer: Galaxy Health WC |
$5,755.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,062.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,857.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,791.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,791.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,037.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,420.52
|
| Rate for Payer: Multiplan Commercial |
$5,416.80
|
| Rate for Payer: Multiplan WC |
$7,634.30
|
| Rate for Payer: Networks By Design Commercial |
$4,401.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,755.35
|
| Rate for Payer: Prime Health Services WC |
$7,556.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,385.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,385.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,385.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,385.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,791.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,187.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,270.57
|
| Rate for Payer: Vantage Medical Group Senior |
$4,791.43
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,348.40 |
| Max. Negotiated Rate |
$5,730.70 |
| Rate for Payer: Adventist Health Commercial |
$1,348.40
|
| Rate for Payer: Cash Price |
$3,033.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,696.80
|
| Rate for Payer: Galaxy Health WC |
$5,730.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,045.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,496.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,568.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,173.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.08
|
| Rate for Payer: Multiplan Commercial |
$5,393.60
|
| Rate for Payer: Networks By Design Commercial |
$4,382.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,730.70
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,348.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,033.90
|
| Rate for Payer: Cash Price |
$3,033.90
|
| Rate for Payer: Cash Price |
$3,033.90
|
| Rate for Payer: Cigna of CA HMO |
$4,314.88
|
| Rate for Payer: Cigna of CA PPO |
$4,989.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,730.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,045.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,496.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,158.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,393.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,382.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,730.70
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,045.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,371.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,371.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,371.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,371.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
IP
|
$6,128.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,225.60 |
| Max. Negotiated Rate |
$5,208.80 |
| Rate for Payer: Adventist Health Commercial |
$1,225.60
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,451.20
|
| Rate for Payer: Galaxy Health WC |
$5,208.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,676.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,087.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,334.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,793.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.72
|
| Rate for Payer: Multiplan Commercial |
$4,902.40
|
| Rate for Payer: Networks By Design Commercial |
$3,983.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,208.80
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
OP
|
$6,128.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,225.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cigna of CA HMO |
$3,921.92
|
| Rate for Payer: Cigna of CA PPO |
$4,534.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$5,208.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,676.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,087.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,980.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$4,902.40
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$3,983.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,208.80
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,676.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,064.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,064.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,064.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,064.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
IP
|
$5,329.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,065.80 |
| Max. Negotiated Rate |
$4,529.65 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| Rate for Payer: Cash Price |
$2,398.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,131.60
|
| Rate for Payer: Galaxy Health WC |
$4,529.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,197.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,554.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,030.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,298.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,278.96
|
| Rate for Payer: Multiplan Commercial |
$4,263.20
|
| Rate for Payer: Networks By Design Commercial |
$3,463.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,529.65
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
OP
|
$5,329.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.22 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,398.05
|
| Rate for Payer: Cash Price |
$2,398.05
|
| Rate for Payer: Cash Price |
$2,398.05
|
| Rate for Payer: Cigna of CA HMO |
$3,410.56
|
| Rate for Payer: Cigna of CA PPO |
$3,943.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,529.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,197.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,554.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,278.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,263.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,463.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,529.65
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,197.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,664.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,664.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,664.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,664.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$445.00 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$445.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$1,001.25
|
| Rate for Payer: Cash Price |
$1,001.25
|
| Rate for Payer: Cash Price |
$1,001.25
|
| Rate for Payer: Cigna of CA HMO |
$1,424.00
|
| Rate for Payer: Cigna of CA PPO |
$1,646.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,891.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,335.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,484.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,780.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,446.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,891.25
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,335.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,112.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,112.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,112.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,112.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$445.00 |
| Max. Negotiated Rate |
$1,891.25 |
| Rate for Payer: Adventist Health Commercial |
$445.00
|
| Rate for Payer: Cash Price |
$1,001.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.00
|
| Rate for Payer: EPIC Health Plan Senior |
$890.00
|
| Rate for Payer: Galaxy Health WC |
$1,891.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,335.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,484.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,377.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.00
|
| Rate for Payer: Multiplan Commercial |
$1,780.00
|
| Rate for Payer: Networks By Design Commercial |
$1,446.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,891.25
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.46 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cigna of CA HMO |
$1,055.36
|
| Rate for Payer: Cigna of CA PPO |
$1,220.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,319.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$989.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.50
|
| Rate for Payer: United Healthcare All Other HMO |
$824.50
|
| Rate for Payer: United Healthcare HMO Rider |
$824.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$1,401.65 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: EPIC Health Plan Senior |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,020.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.76
|
| Rate for Payer: Multiplan Commercial |
$1,319.20
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
|
OP
|
$1,669.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.80 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$333.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cigna of CA HMO |
$1,068.16
|
| Rate for Payer: Cigna of CA PPO |
$1,235.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,418.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,001.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,113.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,335.20
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,084.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,418.65
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.50
|
| Rate for Payer: United Healthcare All Other HMO |
$834.50
|
| Rate for Payer: United Healthcare HMO Rider |
$834.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
|
IP
|
$1,669.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.80 |
| Max. Negotiated Rate |
$1,418.65 |
| Rate for Payer: Adventist Health Commercial |
$333.80
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$667.60
|
| Rate for Payer: Galaxy Health WC |
$1,418.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,001.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,113.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$635.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,033.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.56
|
| Rate for Payer: Multiplan Commercial |
$1,335.20
|
| Rate for Payer: Networks By Design Commercial |
$1,084.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,418.65
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
|
OP
|
$3,011.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.20 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$602.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$1,354.95
|
| Rate for Payer: Cash Price |
$1,354.95
|
| Rate for Payer: Cash Price |
$1,354.95
|
| Rate for Payer: Cigna of CA HMO |
$1,927.04
|
| Rate for Payer: Cigna of CA PPO |
$2,228.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$2,559.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,806.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,008.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$722.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$2,408.80
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,957.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,559.35
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,806.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,505.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,505.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,505.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,505.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
|
IP
|
$3,011.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.20 |
| Max. Negotiated Rate |
$2,559.35 |
| Rate for Payer: Adventist Health Commercial |
$602.20
|
| Rate for Payer: Cash Price |
$1,354.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,204.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,204.40
|
| Rate for Payer: Galaxy Health WC |
$2,559.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,806.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,008.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,147.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,863.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$722.64
|
| Rate for Payer: Multiplan Commercial |
$2,408.80
|
| Rate for Payer: Networks By Design Commercial |
$1,957.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,559.35
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$1,826.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$365.20 |
| Max. Negotiated Rate |
$1,552.10 |
| Rate for Payer: Adventist Health Commercial |
$365.20
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.40
|
| Rate for Payer: EPIC Health Plan Senior |
$730.40
|
| Rate for Payer: Galaxy Health WC |
$1,552.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$695.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,130.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.24
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: Networks By Design Commercial |
$1,186.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.10
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$1,826.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$365.20 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$365.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cigna of CA HMO |
$1,168.64
|
| Rate for Payer: Cigna of CA PPO |
$1,351.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,552.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,186.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.10
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,095.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$913.00
|
| Rate for Payer: United Healthcare All Other HMO |
$913.00
|
| Rate for Payer: United Healthcare HMO Rider |
$913.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$913.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
OP
|
$1,782.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$356.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna of CA HMO |
$1,140.48
|
| Rate for Payer: Cigna of CA PPO |
$1,318.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,188.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,069.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$891.00
|
| Rate for Payer: United Healthcare All Other HMO |
$891.00
|
| Rate for Payer: United Healthcare HMO Rider |
$891.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$891.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
IP
|
$1,782.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$356.40 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Adventist Health Commercial |
$356.40
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.80
|
| Rate for Payer: EPIC Health Plan Senior |
$712.80
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,188.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$678.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,103.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
|
