|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$274.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$177.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.95
|
| 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 |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: Cigna of CA HMO |
$234.24
|
| Rate for Payer: Cigna of CA PPO |
$270.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.40
|
| Rate for Payer: EPIC Health Plan Senior |
$146.40
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$329.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$418.15
|
| Rate for Payer: InnovAge PACE Commercial |
$183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.20
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
| Rate for Payer: Riverside University Health System MISP |
$146.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.60
|
| 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 |
$311.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.10
|
| Rate for Payer: Vantage Medical Group Senior |
$311.10
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$167.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$507.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.80
|
| Rate for Payer: Blue Shield of California Commercial |
$506.85
|
| Rate for Payer: Blue Shield of California EPN |
$331.50
|
| Rate for Payer: Cash Price |
$459.25
|
| Rate for Payer: Cash Price |
$459.25
|
| Rate for Payer: Central Health Plan Commercial |
$668.00
|
| Rate for Payer: Cigna of CA HMO |
$534.40
|
| Rate for Payer: Cigna of CA PPO |
$617.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$709.75
|
| Rate for Payer: Global Benefits Group Commercial |
$501.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$751.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$626.25
|
| Rate for Payer: Networks By Design Commercial |
$542.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$709.75
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$501.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$501.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.00 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$167.00
|
| Rate for Payer: Cash Price |
$459.25
|
| Rate for Payer: Central Health Plan Commercial |
$668.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$334.00
|
| Rate for Payer: Galaxy Health WC |
$709.75
|
| Rate for Payer: Global Benefits Group Commercial |
$501.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$751.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$516.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$626.25
|
| Rate for Payer: Networks By Design Commercial |
$542.75
|
| Rate for Payer: Prime Health Services Commercial |
$709.75
|
|
|
HC DAY PROGRAM FULL DAY
|
Facility
|
IP
|
$1,199.00
|
|
| Hospital Charge Code |
905106001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$239.80 |
| Max. Negotiated Rate |
$1,079.10 |
| Rate for Payer: Adventist Health Commercial |
$239.80
|
| Rate for Payer: Cash Price |
$659.45
|
| Rate for Payer: Central Health Plan Commercial |
$959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.60
|
| Rate for Payer: EPIC Health Plan Senior |
$479.60
|
| Rate for Payer: Galaxy Health WC |
$1,019.15
|
| Rate for Payer: Global Benefits Group Commercial |
$719.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,079.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$742.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.80
|
| Rate for Payer: Multiplan Commercial |
$899.25
|
| Rate for Payer: Networks By Design Commercial |
$779.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,019.15
|
|
|
HC DAY PROGRAM FULL DAY
|
Facility
|
OP
|
$1,199.00
|
|
| Hospital Charge Code |
905106001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,079.10 |
| Rate for Payer: Adventist Health Commercial |
$491.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$728.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,019.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$659.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$899.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$659.45
|
| Rate for Payer: Cash Price |
$659.45
|
| Rate for Payer: Cash Price |
$659.45
|
| Rate for Payer: Central Health Plan Commercial |
$959.20
|
| Rate for Payer: Cigna of CA HMO |
$767.36
|
| Rate for Payer: Cigna of CA PPO |
$887.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,019.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,019.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,019.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.60
|
| Rate for Payer: EPIC Health Plan Senior |
$479.60
|
| Rate for Payer: Galaxy Health WC |
$1,019.15
|
| Rate for Payer: Global Benefits Group Commercial |
$719.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,079.10
|
| Rate for Payer: InnovAge PACE Commercial |
$599.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$742.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$839.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$839.30
|
| Rate for Payer: Multiplan Commercial |
$899.25
|
| Rate for Payer: Networks By Design Commercial |
$779.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,019.15
|
| Rate for Payer: Riverside University Health System MISP |
$479.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$719.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$719.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,019.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,019.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,019.15
|
|
|
HC DAY PROGRAM HALF DAY
|
Facility
|
IP
|
$820.00
|
|
| Hospital Charge Code |
905106000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Central Health Plan Commercial |
$656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.00
|
| Rate for Payer: EPIC Health Plan Senior |
$328.00
|
| Rate for Payer: Galaxy Health WC |
$697.00
|
| Rate for Payer: Global Benefits Group Commercial |
$492.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$546.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Networks By Design Commercial |
$533.00
|
| Rate for Payer: Prime Health Services Commercial |
$697.00
|
|
|
HC DAY PROGRAM HALF DAY
|
Facility
|
OP
|
$820.00
|
|
| Hospital Charge Code |
905106000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$497.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Central Health Plan Commercial |
$656.00
|
| Rate for Payer: Cigna of CA HMO |
$524.80
|
| Rate for Payer: Cigna of CA PPO |
$606.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.00
|
| Rate for Payer: EPIC Health Plan Senior |
$328.00
|
| Rate for Payer: Galaxy Health WC |
$697.00
|
| Rate for Payer: Global Benefits Group Commercial |
$492.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.00
|
| Rate for Payer: InnovAge PACE Commercial |
$410.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$546.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$574.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$574.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Networks By Design Commercial |
$533.00
|
| Rate for Payer: Prime Health Services Commercial |
$697.00
|
| Rate for Payer: Riverside University Health System MISP |
$328.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.00
|
| Rate for Payer: Vantage Medical Group Senior |
$697.00
|
|
|
HC D DIMER
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC D DIMER
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.02
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California EPN |
$32.55
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: InnovAge PACE Commercial |
$15.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$10.79
|
| Rate for Payer: Riverside University Health System MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC D-DIMER
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900912043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.02
|
| Rate for Payer: Blue Shield of California Commercial |
$20.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: InnovAge PACE Commercial |
$15.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$10.79
|
| Rate for Payer: Riverside University Health System MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC D-DIMER
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900912043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC DEB INFCTD SKIN LT 10% BDY SURF
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
902890275
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
|
|
HC DEB INFCTD SKIN LT 10% BDY SURF
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
902890275
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$480.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$688.90
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$750.72
|
| Rate for Payer: Cigna of CA PPO |
$868.02
|
| 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 |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| 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 |
$879.75
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| 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 |
$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 DEB MUSCLE AND OR FASCIA EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
900101492
|
|
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 DEB MUSCLE AND OR FASCIA EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
900101492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.09
|
| 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: 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 |
$53.78
|
| 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 |
$59.41
|
| 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 |
$225.00
|
| 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 DEB OF FX SKIN MUSCLE
|
Facility
|
OP
|
$16,783.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$15,104.70 |
| Rate for Payer: Adventist Health Commercial |
$3,356.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$9,230.65
|
| Rate for Payer: Cash Price |
$9,230.65
|
| Rate for Payer: Cash Price |
$9,230.65
|
| Rate for Payer: Cash Price |
$9,230.65
|
| Rate for Payer: Central Health Plan Commercial |
$13,426.40
|
| Rate for Payer: Cigna of CA HMO |
$10,741.12
|
| Rate for Payer: Cigna of CA PPO |
$12,419.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$14,265.55
|
| Rate for Payer: Global Benefits Group Commercial |
$10,069.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,104.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,194.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,356.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$12,587.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$10,908.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$14,265.55
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,069.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,391.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,391.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,391.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,391.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC DEB OF FX SKIN MUSCLE
|
Facility
|
IP
|
$16,783.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,356.60 |
| Max. Negotiated Rate |
$15,104.70 |
| Rate for Payer: Adventist Health Commercial |
$3,356.60
|
| Rate for Payer: Cash Price |
$9,230.65
|
| Rate for Payer: Central Health Plan Commercial |
$13,426.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,713.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,713.20
|
| Rate for Payer: Galaxy Health WC |
$14,265.55
|
| Rate for Payer: Global Benefits Group Commercial |
$10,069.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,104.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,194.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,394.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,388.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,356.60
|
| Rate for Payer: Multiplan Commercial |
$12,587.25
|
| Rate for Payer: Networks By Design Commercial |
$10,908.95
|
| Rate for Payer: Prime Health Services Commercial |
$14,265.55
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
OP
|
$16,455.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$662.13 |
| Max. Negotiated Rate |
$14,809.50 |
| Rate for Payer: Adventist Health Commercial |
$3,291.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,636.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| 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 |
$10,054.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,565.55
|
| Rate for Payer: Cash Price |
$9,050.25
|
| Rate for Payer: Cash Price |
$9,050.25
|
| Rate for Payer: Cash Price |
$9,050.25
|
| Rate for Payer: Central Health Plan Commercial |
$13,164.00
|
| Rate for Payer: Cigna of CA HMO |
$10,531.20
|
| Rate for Payer: Cigna of CA PPO |
$12,176.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$13,986.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,873.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,809.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$662.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: InnovAge PACE Commercial |
$5,454.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,975.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,291.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,872.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$12,341.25
|
| Rate for Payer: Networks By Design Commercial |
$10,695.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Prime Health Services Commercial |
$13,986.75
|
| Rate for Payer: Prime Health Services Medicare |
$3,854.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,000.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,873.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
IP
|
$16,455.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,291.00 |
| Max. Negotiated Rate |
$14,809.50 |
| Rate for Payer: Adventist Health Commercial |
$3,291.00
|
| Rate for Payer: Cash Price |
$9,050.25
|
| Rate for Payer: Central Health Plan Commercial |
$13,164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,582.00
|
| Rate for Payer: Galaxy Health WC |
$13,986.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,873.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,809.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,975.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,269.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,185.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,291.00
|
| Rate for Payer: Multiplan Commercial |
$12,341.25
|
| Rate for Payer: Networks By Design Commercial |
$10,695.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,986.75
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$3,024.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$604.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,570.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,663.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,268.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,464.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,776.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,847.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,206.58
|
| Rate for Payer: Cash Price |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,663.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,419.20
|
| Rate for Payer: Cigna of CA HMO |
$1,935.36
|
| Rate for Payer: Cigna of CA PPO |
$2,237.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,570.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,570.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,209.60
|
| Rate for Payer: Galaxy Health WC |
$2,570.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,721.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,017.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,871.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,116.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,116.80
|
| Rate for Payer: Multiplan Commercial |
$2,268.00
|
| Rate for Payer: Networks By Design Commercial |
$1,965.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,570.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,209.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,814.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,512.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,512.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,570.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,570.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,570.40
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$3,024.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$2,721.60 |
| Rate for Payer: Adventist Health Commercial |
$604.80
|
| Rate for Payer: Cash Price |
$1,663.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,419.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,209.60
|
| Rate for Payer: Galaxy Health WC |
$2,570.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,721.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,017.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,152.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,871.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.80
|
| Rate for Payer: Multiplan Commercial |
$2,268.00
|
| Rate for Payer: Networks By Design Commercial |
$1,965.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,570.40
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$308.70 |
| Rate for Payer: Adventist Health Commercial |
$68.60
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Central Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$137.20
|
| Rate for Payer: Galaxy Health WC |
$291.55
|
| Rate for Payer: Global Benefits Group Commercial |
$205.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.60
|
| Rate for Payer: Multiplan Commercial |
$257.25
|
| Rate for Payer: Networks By Design Commercial |
$222.95
|
| Rate for Payer: Prime Health Services Commercial |
$291.55
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$140.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.44
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$120.25
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Central Health Plan Commercial |
$274.40
|
| Rate for Payer: Cigna of CA HMO |
$219.52
|
| Rate for Payer: Cigna of CA PPO |
$253.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$291.55
|
| Rate for Payer: Global Benefits Group Commercial |
$205.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$257.25
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$222.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$291.55
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.80
|
| 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 |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$308.70 |
| Rate for Payer: Adventist Health Commercial |
$68.60
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Central Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$137.20
|
| Rate for Payer: Galaxy Health WC |
$291.55
|
| Rate for Payer: Global Benefits Group Commercial |
$205.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.60
|
| Rate for Payer: Multiplan Commercial |
$257.25
|
| Rate for Payer: Networks By Design Commercial |
$222.95
|
| Rate for Payer: Prime Health Services Commercial |
$291.55
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$68.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$120.25
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Cash Price |
$188.65
|
| Rate for Payer: Central Health Plan Commercial |
$274.40
|
| Rate for Payer: Cigna of CA HMO |
$219.52
|
| Rate for Payer: Cigna of CA PPO |
$253.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$291.55
|
| Rate for Payer: Global Benefits Group Commercial |
$205.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$257.25
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$222.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$291.55
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.50
|
| Rate for Payer: United Healthcare All Other HMO |
$171.50
|
| Rate for Payer: United Healthcare HMO Rider |
$171.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
