|
HC DENNIS BROWNE CLAMPED
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
915353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Commercial |
$72.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.54
|
| Rate for Payer: Blue Shield of California Commercial |
$142.76
|
| Rate for Payer: Blue Shield of California EPN |
$89.71
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Riverside University Health System MISP |
$71.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
OP
|
$702.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$426.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$339.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.35
|
| Rate for Payer: Blue Shield of California Commercial |
$442.26
|
| Rate for Payer: Blue Shield of California EPN |
$278.69
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
IP
|
$702.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC DERMABOND
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.95
|
| Rate for Payer: Blue Shield of California Commercial |
$50.09
|
| Rate for Payer: Blue Shield of California EPN |
$31.52
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Riverside University Health System MISP |
$31.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC DERMABOND
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$159.88 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.88
|
| Rate for Payer: Blue Shield of California Commercial |
$41.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
IP
|
$8,996.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,799.20 |
| Max. Negotiated Rate |
$8,096.40 |
| Rate for Payer: Adventist Health Commercial |
$1,799.20
|
| Rate for Payer: Cash Price |
$4,048.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,196.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,297.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,598.40
|
| Rate for Payer: Galaxy Health WC |
$7,646.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,397.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,096.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,712.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,307.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,799.20
|
| Rate for Payer: Multiplan Commercial |
$6,747.00
|
| Rate for Payer: Networks By Design Commercial |
$5,847.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,646.60
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
OP
|
$8,996.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$306.44 |
| Max. Negotiated Rate |
$8,096.40 |
| Rate for Payer: Adventist Health Commercial |
$1,799.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,562.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,646.08
|
| Rate for Payer: Blue Shield of California Commercial |
$5,667.48
|
| Rate for Payer: Blue Shield of California EPN |
$3,571.41
|
| Rate for Payer: Cash Price |
$4,048.20
|
| Rate for Payer: Cash Price |
$4,048.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,196.80
|
| Rate for Payer: Cigna of CA HMO |
$5,757.44
|
| Rate for Payer: Cigna of CA PPO |
$6,657.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,297.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$7,646.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,397.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,096.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,712.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$338.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,799.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$6,747.00
|
| Rate for Payer: Networks By Design Commercial |
$5,847.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,646.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,397.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,397.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC DESIGN MIC DEVICE FOR IMRT
|
Facility
|
OP
|
$2,982.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
909100215
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$481.58 |
| Max. Negotiated Rate |
$2,683.80 |
| Rate for Payer: Adventist Health Commercial |
$596.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$481.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,661.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,855.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,579.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,878.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,183.85
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,385.60
|
| Rate for Payer: Cigna of CA HMO |
$1,908.48
|
| Rate for Payer: Cigna of CA PPO |
$2,206.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,087.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$2,534.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,789.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,683.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$712.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,893.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$786.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$2,236.50
|
| Rate for Payer: Networks By Design Commercial |
$1,938.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$481.58
|
| Rate for Payer: Prime Health Services Commercial |
$2,534.70
|
| Rate for Payer: Prime Health Services Medicare |
$510.47
|
| Rate for Payer: Riverside University Health System MISP |
$529.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,789.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC DESIGN MIC DEVICE FOR IMRT
|
Facility
|
IP
|
$2,982.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
909100215
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$596.40 |
| Max. Negotiated Rate |
$2,683.80 |
| Rate for Payer: Adventist Health Commercial |
$596.40
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,385.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,087.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,192.80
|
| Rate for Payer: Galaxy Health WC |
$2,534.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,789.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,683.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,893.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,759.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.40
|
| Rate for Payer: Multiplan Commercial |
$2,236.50
|
| Rate for Payer: Networks By Design Commercial |
$1,938.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,534.70
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$368.10 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$286.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.60
|
| Rate for Payer: EPIC Health Plan Senior |
$163.60
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| 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 |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: Cigna of CA HMO |
$261.76
|
| Rate for Payer: Cigna of CA PPO |
$302.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$286.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$245.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.50
|
| Rate for Payer: United Healthcare All Other HMO |
$204.50
|
| Rate for Payer: United Healthcare HMO Rider |
$204.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$167.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$316.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: Cigna of CA HMO |
$261.76
|
| Rate for Payer: Cigna of CA PPO |
$302.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$286.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$245.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$245.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$368.10 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$286.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.60
|
| Rate for Payer: EPIC Health Plan Senior |
$163.60
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$540.90 |
| Rate for Payer: Adventist Health Commercial |
$120.20
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Central Health Plan Commercial |
$480.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$420.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$240.40
|
| Rate for Payer: Galaxy Health WC |
$510.85
|
| Rate for Payer: Global Benefits Group Commercial |
$360.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$354.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.20
|
| Rate for Payer: Multiplan Commercial |
$450.75
|
| Rate for Payer: Networks By Design Commercial |
$390.65
|
| Rate for Payer: Prime Health Services Commercial |
$510.85
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$246.41
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Central Health Plan Commercial |
$480.80
|
| Rate for Payer: Cigna of CA HMO |
$384.64
|
| Rate for Payer: Cigna of CA PPO |
$444.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$420.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$510.85
|
| Rate for Payer: Global Benefits Group Commercial |
$360.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$450.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$390.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$510.85
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$360.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$540.90 |
| Rate for Payer: Adventist Health Commercial |
$120.20
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Central Health Plan Commercial |
$480.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$420.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$240.40
|
| Rate for Payer: Galaxy Health WC |
$510.85
|
| Rate for Payer: Global Benefits Group Commercial |
$360.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$354.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.20
|
| Rate for Payer: Multiplan Commercial |
$450.75
|
| Rate for Payer: Networks By Design Commercial |
$390.65
|
| Rate for Payer: Prime Health Services Commercial |
$510.85
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$120.20
|
| 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 |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Cash Price |
$270.45
|
| Rate for Payer: Central Health Plan Commercial |
$480.80
|
| Rate for Payer: Cigna of CA HMO |
$384.64
|
| Rate for Payer: Cigna of CA PPO |
$444.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$420.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$510.85
|
| Rate for Payer: Global Benefits Group Commercial |
$360.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$450.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$390.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$510.85
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$300.50
|
| Rate for Payer: United Healthcare All Other HMO |
$300.50
|
| Rate for Payer: United Healthcare HMO Rider |
$300.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| 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 |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Central Health Plan Commercial |
$771.20
|
| Rate for Payer: Cigna of CA HMO |
$616.96
|
| Rate for Payer: Cigna of CA PPO |
$713.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$867.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$612.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$578.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$482.00
|
| Rate for Payer: United Healthcare All Other HMO |
$482.00
|
| Rate for Payer: United Healthcare HMO Rider |
$482.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$482.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$395.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Central Health Plan Commercial |
$771.20
|
| Rate for Payer: Cigna of CA HMO |
$616.96
|
| Rate for Payer: Cigna of CA PPO |
$713.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$867.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$612.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$578.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$578.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Central Health Plan Commercial |
$771.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$867.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$612.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$568.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.80
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$867.60 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Central Health Plan Commercial |
$771.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$867.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$612.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$568.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.80
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
OP
|
$1,326.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$265.20
|
| 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 |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Cigna of CA HMO |
$848.64
|
| Rate for Payer: Cigna of CA PPO |
$981.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$842.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$601.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$795.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$663.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
IP
|
$1,326.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$265.20
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.40
|
| Rate for Payer: EPIC Health Plan Senior |
$530.40
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$842.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$782.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
|
