|
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 |
$3,370.40
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cash Price |
$3,370.40
|
| 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 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 |
$3,370.40
|
| 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 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 |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| 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 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 |
$2,930.95
|
| 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 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 |
$1,223.75
|
| Rate for Payer: Cash Price |
$1,223.75
|
| Rate for Payer: Cash Price |
$1,223.75
|
| 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 |
$1,223.75
|
| 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
|
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 |
$906.95
|
| 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, 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 |
$906.95
|
| Rate for Payer: Cash Price |
$906.95
|
| Rate for Payer: Cash Price |
$906.95
|
| 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 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 |
$917.95
|
| 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 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 |
$917.95
|
| Rate for Payer: Cash Price |
$917.95
|
| Rate for Payer: Cash Price |
$917.95
|
| 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 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 |
$1,656.05
|
| Rate for Payer: Cash Price |
$1,656.05
|
| Rate for Payer: Cash Price |
$1,656.05
|
| 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 |
$1,656.05
|
| 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
|
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 |
$1,004.30
|
| Rate for Payer: Cash Price |
$1,004.30
|
| Rate for Payer: Cash Price |
$1,004.30
|
| 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, 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 |
$1,004.30
|
| 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, 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 |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| 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 |
$980.10
|
| 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
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
IP
|
$2,582.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$516.40 |
| Max. Negotiated Rate |
$2,194.70 |
| Rate for Payer: Adventist Health Commercial |
$516.40
|
| Rate for Payer: Cash Price |
$1,420.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,032.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,032.80
|
| Rate for Payer: Galaxy Health WC |
$2,194.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,549.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,722.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$983.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,598.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.68
|
| Rate for Payer: Multiplan Commercial |
$2,065.60
|
| Rate for Payer: Networks By Design Commercial |
$1,678.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,194.70
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
OP
|
$2,582.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$516.40 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$516.40
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,420.10
|
| Rate for Payer: Cash Price |
$1,420.10
|
| Rate for Payer: Cash Price |
$1,420.10
|
| Rate for Payer: Cigna of CA HMO |
$1,652.48
|
| Rate for Payer: Cigna of CA PPO |
$1,910.68
|
| 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 |
$2,194.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,549.20
|
| 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 |
$1,722.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.68
|
| 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 |
$2,065.60
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,678.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,194.70
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,549.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,291.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,291.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,291.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,291.00
|
| 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 EA ADD 5 CM OR LT,SCAL
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$381.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,048.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,429.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,048.30
|
| Rate for Payer: Cash Price |
$1,048.30
|
| Rate for Payer: Cash Price |
$1,048.30
|
| Rate for Payer: Cigna of CA HMO |
$1,219.84
|
| Rate for Payer: Cigna of CA PPO |
$1,410.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: EPIC Health Plan Senior |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,271.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,179.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,334.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,334.20
|
| Rate for Payer: Multiplan Commercial |
$1,524.80
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,143.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$953.00
|
| Rate for Payer: United Healthcare All Other HMO |
$953.00
|
| Rate for Payer: United Healthcare HMO Rider |
$953.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$953.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.10
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$1,620.10 |
| Rate for Payer: Adventist Health Commercial |
$381.20
|
| Rate for Payer: Cash Price |
$1,048.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: EPIC Health Plan Senior |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,271.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,179.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.44
|
| Rate for Payer: Multiplan Commercial |
$1,524.80
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,389.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$899.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,226.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,389.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,389.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,389.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,012.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,144.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,144.50
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.50
|
| Rate for Payer: United Healthcare All Other HMO |
$817.50
|
| Rate for Payer: United Healthcare HMO Rider |
$817.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$817.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,389.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,389.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,389.75
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,012.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,076.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,468.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: Cigna of CA HMO |
$1,253.12
|
| Rate for Payer: Cigna of CA PPO |
$1,448.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,664.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,664.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,370.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,370.60
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.00
|
| Rate for Payer: United Healthcare All Other HMO |
$979.00
|
| Rate for Payer: United Healthcare HMO Rider |
$979.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$979.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,664.30
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$1,664.30 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Cash Price |
$1,076.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
OP
|
$6,877.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$567.30 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,782.35
|
| Rate for Payer: Cash Price |
$3,782.35
|
| Rate for Payer: Cash Price |
$3,782.35
|
| Rate for Payer: Cigna of CA HMO |
$4,401.28
|
| Rate for Payer: Cigna of CA PPO |
$5,088.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$5,845.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,126.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$5,501.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,470.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,845.45
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,126.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,438.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,438.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
