|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
915353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$686.11 |
| Max. Negotiated Rate |
$1,885.50 |
| Rate for Payer: Adventist Health Commercial |
$858.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,152.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,571.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,218.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,680.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.88
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.00
|
| Rate for Payer: Cigna of CA HMO |
$1,466.50
|
| Rate for Payer: Cigna of CA PPO |
$1,466.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,780.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,780.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,466.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,885.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,336.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,330.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,236.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,466.50
|
| Rate for Payer: Multiplan Commercial |
$1,571.25
|
| Rate for Payer: Networks By Design Commercial |
$1,047.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: Riverside University Health System MISP |
$838.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,257.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.25
|
| Rate for Payer: United Healthcare All Other HMO |
$765.30
|
| Rate for Payer: United Healthcare HMO Rider |
$748.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.75
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$1,885.50 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,680.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.88
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.00
|
| Rate for Payer: Cigna of CA HMO |
$1,466.50
|
| Rate for Payer: Cigna of CA PPO |
$1,466.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,466.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,885.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,330.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,236.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.00
|
| Rate for Payer: Multiplan Commercial |
$1,571.25
|
| Rate for Payer: Networks By Design Commercial |
$1,361.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.25
|
| Rate for Payer: United Healthcare All Other HMO |
$765.30
|
| Rate for Payer: United Healthcare HMO Rider |
$748.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.11
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
915353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$663.19 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,177.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,624.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,336.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Riverside University Health System MISP |
$810.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
915353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,624.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EXAMINATION OF VAGINA
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
904000018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Central Health Plan Commercial |
$514.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$578.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.60
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC EXAMINATION OF VAGINA
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
904000018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$260.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$407.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Central Health Plan Commercial |
$514.40
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.05
|
| Rate for Payer: EPIC Health Plan Senior |
$286.03
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$578.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$426.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$199.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$260.03
|
| Rate for Payer: Preferred Health Network WC |
$415.58
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Prime Health Services Medicare |
$275.63
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Riverside University Health System MISP |
$286.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| 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: Upland Medical Group Pediatric |
$260.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
IP
|
$4,209.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$841.80 |
| Max. Negotiated Rate |
$3,788.10 |
| Rate for Payer: Adventist Health Commercial |
$841.80
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,367.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,946.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,683.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,683.60
|
| Rate for Payer: Galaxy Health WC |
$3,577.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,525.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,788.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,672.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,483.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$3,156.75
|
| Rate for Payer: Networks By Design Commercial |
$2,735.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,577.65
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$4,209.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,725.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$626.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,367.20
|
| Rate for Payer: Cigna of CA HMO |
$2,693.76
|
| Rate for Payer: Cigna of CA PPO |
$3,114.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,946.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$3,577.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,525.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,788.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,672.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$3,156.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,735.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$3,577.65
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,525.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,525.40
|
| 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 |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
IP
|
$4,209.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$841.80 |
| Max. Negotiated Rate |
$3,788.10 |
| Rate for Payer: Adventist Health Commercial |
$841.80
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,367.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,946.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,683.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,683.60
|
| Rate for Payer: Galaxy Health WC |
$3,577.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,525.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,788.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,672.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,483.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$3,156.75
|
| Rate for Payer: Networks By Design Commercial |
$2,735.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,577.65
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
IP
|
$4,209.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$841.80 |
| Max. Negotiated Rate |
$3,788.10 |
| Rate for Payer: Adventist Health Commercial |
$841.80
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,367.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,946.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,683.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,683.60
|
| Rate for Payer: Galaxy Health WC |
$3,577.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,525.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,788.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,672.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,483.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$3,156.75
|
| Rate for Payer: Networks By Design Commercial |
$2,735.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,577.65
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$4,209.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.58 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$841.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,367.20
|
| Rate for Payer: Cigna of CA HMO |
$2,693.76
|
| Rate for Payer: Cigna of CA PPO |
$3,114.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,946.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$3,577.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,525.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,788.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,672.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$3,156.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,735.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$3,577.65
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,525.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,104.50
|
| 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 |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$4,209.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$841.80
|
| 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 |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Cash Price |
$1,894.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,367.20
|
| Rate for Payer: Cigna of CA HMO |
$2,693.76
|
| Rate for Payer: Cigna of CA PPO |
$3,114.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,946.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$3,577.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,525.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,788.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,672.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$3,156.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,735.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$3,577.65
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,525.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,104.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,104.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,104.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,104.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
OP
|
$5,346.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.47 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,069.20
|
| 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 |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$2,405.70
|
| Rate for Payer: Cash Price |
$2,405.70
|
| Rate for Payer: Cash Price |
$2,405.70
|
| Rate for Payer: Cash Price |
$2,405.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,276.80
|
| Rate for Payer: Cigna of CA HMO |
$3,421.44
|
| Rate for Payer: Cigna of CA PPO |
$3,956.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,742.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$4,544.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,811.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,394.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$4,009.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$3,474.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$4,544.10
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,207.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,673.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,673.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,673.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
OP
|
$5,346.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.55 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,069.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,405.70
|
| Rate for Payer: Cash Price |
$2,405.70
|
| Rate for Payer: Cash Price |
$2,405.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,276.80
|
| Rate for Payer: Cigna of CA HMO |
$3,421.44
|
| Rate for Payer: Cigna of CA PPO |
$3,956.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,742.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$4,544.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,811.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,394.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$4,009.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$3,474.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$4,544.10
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,207.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,673.00
|
| 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 |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
IP
|
$5,346.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,069.20 |
| Max. Negotiated Rate |
$4,811.40 |
| Rate for Payer: Adventist Health Commercial |
$1,069.20
|
| Rate for Payer: Cash Price |
$2,405.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,276.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,742.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,138.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,138.40
|
| Rate for Payer: Galaxy Health WC |
$4,544.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,811.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,394.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,154.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.20
|
| Rate for Payer: Multiplan Commercial |
$4,009.50
|
| Rate for Payer: Networks By Design Commercial |
$3,474.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,544.10
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
IP
|
$5,346.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,069.20 |
| Max. Negotiated Rate |
$4,811.40 |
| Rate for Payer: Adventist Health Commercial |
$1,069.20
|
| Rate for Payer: Cash Price |
$2,405.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,276.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,742.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,138.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,138.40
|
| Rate for Payer: Galaxy Health WC |
$4,544.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,811.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,394.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,154.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.20
|
| Rate for Payer: Multiplan Commercial |
$4,009.50
|
| Rate for Payer: Networks By Design Commercial |
$3,474.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,544.10
|
|
|
HC EX BENIGN LES 3.1 - 4.0 CM
|
Facility
|
IP
|
$8,074.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
900501791
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,614.80 |
| Max. Negotiated Rate |
$7,266.60 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,651.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,229.60
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,126.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,763.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
|
|
HC EX BENIGN LES 3.1 - 4.0 CM
|
Facility
|
OP
|
$8,074.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
900501791
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.41 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: Cigna of CA HMO |
$5,167.36
|
| Rate for Payer: Cigna of CA PPO |
$5,974.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,651.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,126.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,844.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,037.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC EX BENIGN LES GT 4CM
|
Facility
|
OP
|
$10,459.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,413.10 |
| Rate for Payer: Adventist Health Commercial |
$4,288.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,305.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Cash Price |
$4,706.55
|
| Rate for Payer: Cash Price |
$4,706.55
|
| Rate for Payer: Cash Price |
$4,706.55
|
| Rate for Payer: Cash Price |
$4,706.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,367.20
|
| Rate for Payer: Cigna of CA HMO |
$6,693.76
|
| Rate for Payer: Cigna of CA PPO |
$7,739.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$8,890.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,413.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,641.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$550.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,091.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$7,844.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$6,798.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$8,890.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,275.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,275.40
|
| 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 |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC EX BENIGN LES GT 4CM
|
Facility
|
OP
|
$10,459.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$498.54 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,091.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$4,706.55
|
| Rate for Payer: Cash Price |
$4,706.55
|
| Rate for Payer: Cash Price |
$4,706.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,367.20
|
| Rate for Payer: Cigna of CA HMO |
$6,693.76
|
| Rate for Payer: Cigna of CA PPO |
$7,739.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$8,890.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,413.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$498.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,641.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$550.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,091.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$7,844.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$6,798.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$8,890.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,229.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC EX BENIGN LES GT 4CM
|
Facility
|
IP
|
$10,459.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,091.80 |
| Max. Negotiated Rate |
$9,413.10 |
| Rate for Payer: Adventist Health Commercial |
$2,091.80
|
| Rate for Payer: Cash Price |
$4,706.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,367.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,183.60
|
| Rate for Payer: Galaxy Health WC |
$8,890.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,413.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,641.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,170.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,091.80
|
| Rate for Payer: Multiplan Commercial |
$7,844.25
|
| Rate for Payer: Networks By Design Commercial |
$6,798.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,890.15
|
|
|
HC EX BENIGN LES GT 4CM
|
Facility
|
IP
|
$10,459.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,091.80 |
| Max. Negotiated Rate |
$9,413.10 |
| Rate for Payer: Adventist Health Commercial |
$2,091.80
|
| Rate for Payer: Cash Price |
$4,706.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,367.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,183.60
|
| Rate for Payer: Galaxy Health WC |
$8,890.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,413.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,641.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,170.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,091.80
|
| Rate for Payer: Multiplan Commercial |
$7,844.25
|
| Rate for Payer: Networks By Design Commercial |
$6,798.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,890.15
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
IP
|
$5,462.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,092.40 |
| Max. Negotiated Rate |
$4,915.80 |
| Rate for Payer: Adventist Health Commercial |
$1,092.40
|
| Rate for Payer: Cash Price |
$2,457.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,369.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,823.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,184.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,184.80
|
| Rate for Payer: Galaxy Health WC |
$4,642.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,277.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,915.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,468.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,222.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,092.40
|
| Rate for Payer: Multiplan Commercial |
$4,096.50
|
| Rate for Payer: Networks By Design Commercial |
$3,550.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,642.70
|
|
