|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,018.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$696.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$999.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.96
|
| Rate for Payer: Blue Shield of California Commercial |
$999.12
|
| Rate for Payer: Blue Shield of California EPN |
$653.46
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$933.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$696.67
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$738.47
|
| Rate for Payer: Riverside University Health System MISP |
$766.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$696.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$999.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$966.70
|
| Rate for Payer: Blue Shield of California Commercial |
$999.12
|
| Rate for Payer: Blue Shield of California EPN |
$653.46
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$933.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$696.67
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$738.47
|
| Rate for Payer: Riverside University Health System MISP |
$766.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,356.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$777.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.31
|
| Rate for Payer: Blue Shield of California EPN |
$874.61
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Cigna of CA HMO |
$1,402.88
|
| Rate for Payer: Cigna of CA PPO |
$1,622.08
|
| 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 |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$112.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.00
|
| 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 SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$669.04
|
| Rate for Payer: Blue Shield of California EPN |
$436.90
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.26
|
| Rate for Payer: InnovAge PACE Commercial |
$547.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.85 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,324.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,371.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,854.84
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: Cigna of CA HMO |
$4,579.20
|
| Rate for Payer: Cigna of CA PPO |
$5,294.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,293.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,293.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,577.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.00 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,862.00
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,726.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,428.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.60 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,386.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,363.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,683.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Cigna of CA HMO |
$2,289.92
|
| Rate for Payer: Cigna of CA PPO |
$2,647.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,041.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,041.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,789.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,386.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,504.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,504.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,431.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,789.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,041.30
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.76
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: InnovAge PACE Commercial |
$12.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.65
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Medicare |
$9.17
|
| Rate for Payer: Riverside University Health System MISP |
$9.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
905352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$115.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
905352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.09
|
| Rate for Payer: Blue Shield of California Commercial |
$115.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.20
|
| Rate for Payer: InnovAge PACE Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
915352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.09
|
| Rate for Payer: Blue Shield of California Commercial |
$115.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.20
|
| Rate for Payer: InnovAge PACE Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
915352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$115.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC SUTR AND STPL REMOVAL NOT REQ ANES
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
907205854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$654.30 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Cash Price |
$399.85
|
| Rate for Payer: Central Health Plan Commercial |
$581.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.80
|
| Rate for Payer: EPIC Health Plan Senior |
$290.80
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$654.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$450.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.40
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
|
|
HC SUTR AND STPL REMOVAL NOT REQ ANES
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
907205854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$617.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$399.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$545.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$352.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$399.85
|
| Rate for Payer: Cash Price |
$399.85
|
| Rate for Payer: Central Health Plan Commercial |
$581.60
|
| Rate for Payer: Cigna of CA HMO |
$465.28
|
| Rate for Payer: Cigna of CA PPO |
$537.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$617.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$617.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$617.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.80
|
| Rate for Payer: EPIC Health Plan Senior |
$290.80
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$654.30
|
| Rate for Payer: InnovAge PACE Commercial |
$363.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$450.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.90
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
| Rate for Payer: Riverside University Health System MISP |
$290.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$436.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$617.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$617.95
|
| Rate for Payer: Vantage Medical Group Senior |
$617.95
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
IP
|
$7,970.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,594.00 |
| Max. Negotiated Rate |
$7,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,315.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,036.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,933.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
IP
|
$7,970.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,594.00 |
| Max. Negotiated Rate |
$7,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,315.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,036.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,933.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
OP
|
$7,970.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,383.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,977.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: Cigna of CA HMO |
$5,100.80
|
| Rate for Payer: Cigna of CA PPO |
$5,897.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,774.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,985.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,315.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,036.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,933.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,579.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,188.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,985.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,985.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,985.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,985.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,774.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,774.50
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
OP
|
$7,970.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,594.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,383.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,977.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,859.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,680.78
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: Cigna of CA HMO |
$5,100.80
|
| Rate for Payer: Cigna of CA PPO |
$5,897.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,774.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,985.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,315.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,036.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,933.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,579.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,188.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,985.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,985.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,985.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,985.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,774.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,774.50
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$459.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$404.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: Central Health Plan Commercial |
$668.80
|
| Rate for Payer: Cigna of CA HMO |
$535.04
|
| Rate for Payer: Cigna of CA PPO |
$618.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$710.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$710.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$334.40
|
| Rate for Payer: Galaxy Health WC |
$710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$501.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$752.40
|
| Rate for Payer: InnovAge PACE Commercial |
$418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$557.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$517.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$585.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$585.20
|
| Rate for Payer: Multiplan Commercial |
$627.00
|
| Rate for Payer: Networks By Design Commercial |
$543.40
|
| Rate for Payer: Prime Health Services Commercial |
$710.60
|
| Rate for Payer: Riverside University Health System MISP |
$334.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$501.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$710.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Vantage Medical Group Senior |
$710.60
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$752.40 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: Central Health Plan Commercial |
$668.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$334.40
|
| Rate for Payer: Galaxy Health WC |
$710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$501.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$752.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$557.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$517.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.20
|
| Rate for Payer: Multiplan Commercial |
$627.00
|
| Rate for Payer: Networks By Design Commercial |
$543.40
|
| Rate for Payer: Prime Health Services Commercial |
$710.60
|
|
