|
HC EXC FACIAL LESION LT 0.5 CM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
902890018
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$640.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Adventist Health Commercial |
$640.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,560.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,280.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,280.00
|
| Rate for Payer: Galaxy Health WC |
$2,720.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,920.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,880.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,032.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,888.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.00
|
| Rate for Payer: Multiplan Commercial |
$2,400.00
|
| Rate for Payer: Networks By Design Commercial |
$2,080.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,720.00
|
|
|
HC EXC FACIAL LESION LT 0.5 CM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
902890018
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,312.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.70
|
| 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 |
$1,440.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,560.00
|
| Rate for Payer: Cigna of CA HMO |
$2,048.00
|
| Rate for Payer: Cigna of CA PPO |
$2,368.00
|
| 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 |
$2,240.00
|
| 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 |
$2,720.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,920.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,880.00
|
| 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 |
$2,032.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,400.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,080.00
|
| 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 |
$2,720.00
|
| 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 |
$1,920.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,920.00
|
| 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 EXCHANGE STEERABLE GW
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.51
|
| Rate for Payer: Blue Shield of California Commercial |
$190.20
|
| Rate for Payer: Blue Shield of California EPN |
$119.70
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC EXCHANGE STEERABLE GW
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC EXCHG BLD TRANS NEWBORN
|
Facility
|
OP
|
$2,017.00
|
|
|
Service Code
|
CPT 36450
|
| Hospital Charge Code |
906812206
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$224.77 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$403.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$670.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| 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: Blue Shield of California Commercial |
$1,278.78
|
| Rate for Payer: Blue Shield of California EPN |
$804.78
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,613.60
|
| Rate for Payer: Cigna of CA HMO |
$1,290.88
|
| Rate for Payer: Cigna of CA PPO |
$1,492.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,411.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,714.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,210.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,815.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$224.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,280.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,512.75
|
| Rate for Payer: Networks By Design Commercial |
$1,311.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,714.45
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,210.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,210.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC EXCHG BLD TRANS NEWBORN
|
Facility
|
IP
|
$2,017.00
|
|
|
Service Code
|
CPT 36450
|
| Hospital Charge Code |
906812206
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$403.40 |
| Max. Negotiated Rate |
$1,815.30 |
| Rate for Payer: Adventist Health Commercial |
$403.40
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,613.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,411.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$806.80
|
| Rate for Payer: Galaxy Health WC |
$1,714.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,210.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,815.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,280.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,190.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.40
|
| Rate for Payer: Multiplan Commercial |
$1,512.75
|
| Rate for Payer: Networks By Design Commercial |
$1,311.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,714.45
|
|
|
HC EXCHG BLD TRANS OTHER THAN NEWBORN
|
Facility
|
IP
|
$2,017.00
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
906812205
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$403.40 |
| Max. Negotiated Rate |
$1,815.30 |
| Rate for Payer: Adventist Health Commercial |
$403.40
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,613.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,411.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$806.80
|
| Rate for Payer: Galaxy Health WC |
$1,714.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,210.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,815.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,280.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,190.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.40
|
| Rate for Payer: Multiplan Commercial |
$1,512.75
|
| Rate for Payer: Networks By Design Commercial |
$1,311.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,714.45
|
|
|
HC EXCHG BLD TRANS OTHER THAN NEWBORN
|
Facility
|
OP
|
$2,017.00
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
906812205
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$403.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$703.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,278.78
|
| Rate for Payer: Blue Shield of California EPN |
$804.78
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Cash Price |
$907.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,613.60
|
| Rate for Payer: Cigna of CA HMO |
$1,290.88
|
| Rate for Payer: Cigna of CA PPO |
$1,492.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,411.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,714.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,210.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,815.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$199.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,280.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,512.75
|
| Rate for Payer: Networks By Design Commercial |
$1,311.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,714.45
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,210.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,210.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC EXCISION ANAL LESION(S)
|
Facility
|
IP
|
$6,378.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
904000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,275.60 |
| Max. Negotiated Rate |
$5,740.20 |
| Rate for Payer: Adventist Health Commercial |
$1,275.60
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,102.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,464.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,551.20
|
| Rate for Payer: Galaxy Health WC |
$5,421.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,740.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,050.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,763.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.60
|
| Rate for Payer: Multiplan Commercial |
$4,783.50
|
| Rate for Payer: Networks By Design Commercial |
$4,145.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,421.30
|
|
|
HC EXCISION ANAL LESION(S)
|
Facility
|
OP
|
$6,378.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
904000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.93 |
| Max. Negotiated Rate |
$5,890.43 |
| Rate for Payer: Adventist Health Commercial |
$1,275.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,569.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| 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: Blue Shield of California Commercial |
$4,043.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,544.82
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,102.40
|
| Rate for Payer: Cigna of CA HMO |
$4,081.92
|
| Rate for Payer: Cigna of CA PPO |
$4,719.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,464.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Galaxy Health WC |
$5,421.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,740.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$163.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,050.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$181.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan Commercial |
$4,783.50
|
| Rate for Payer: Networks By Design Commercial |
$4,145.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Prime Health Services Commercial |
$5,421.30
|
| Rate for Payer: Prime Health Services Medicare |
$3,784.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,926.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,826.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,826.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,189.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,189.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,189.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,189.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
HC EXCISION, NASAL POLYP(S), SIMPLE
|
Facility
|
OP
|
$4,989.00
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
900501190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.45 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$997.80
|
| 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 |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$2,245.05
|
| Rate for Payer: Cash Price |
$2,245.05
|
| Rate for Payer: Cash Price |
$2,245.05
|
| Rate for Payer: Cash Price |
$2,245.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,991.20
|
| Rate for Payer: Cigna of CA HMO |
$3,192.96
|
| Rate for Payer: Cigna of CA PPO |
$3,691.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,492.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$4,240.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,993.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,490.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,168.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$3,741.75
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,242.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$4,240.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,115.34
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,195.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,993.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,494.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC EXCISION, NASAL POLYP(S), SIMPLE
|
Facility
|
IP
|
$4,989.00
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
900501190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$997.80 |
| Max. Negotiated Rate |
$4,490.10 |
| Rate for Payer: Adventist Health Commercial |
$997.80
|
| Rate for Payer: Cash Price |
$2,245.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,991.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,492.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,995.60
|
| Rate for Payer: Galaxy Health WC |
$4,240.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,993.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,490.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,168.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,943.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.80
|
| Rate for Payer: Multiplan Commercial |
$3,741.75
|
| Rate for Payer: Networks By Design Commercial |
$3,242.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,240.65
|
|
|
HC EXCISION OF CYST, FIBROADENOMA OR OTHER BENIGN OR MAGLIGNANT TUMOR
|
Facility
|
IP
|
$13,254.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
950442246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,650.80 |
| Max. Negotiated Rate |
$11,928.60 |
| Rate for Payer: Adventist Health Commercial |
$2,650.80
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,603.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,277.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,301.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,301.60
|
| Rate for Payer: Galaxy Health WC |
$11,265.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,952.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,928.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,416.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.80
|
| Rate for Payer: Multiplan Commercial |
$9,940.50
|
| Rate for Payer: Networks By Design Commercial |
$8,615.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,265.90
|
|
|
HC EXCISION OF CYST, FIBROADENOMA OR OTHER BENIGN OR MAGLIGNANT TUMOR
|
Facility
|
OP
|
$13,254.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
950442246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$362.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,650.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,603.20
|
| Rate for Payer: Cigna of CA HMO |
$8,482.56
|
| Rate for Payer: Cigna of CA PPO |
$9,807.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,277.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$11,265.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,952.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,928.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,416.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$9,940.50
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$8,615.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$11,265.90
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,952.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,627.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
OP
|
$10,150.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$9,135.00 |
| Rate for Payer: Adventist Health Commercial |
$2,030.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,120.00
|
| Rate for Payer: Cigna of CA HMO |
$6,496.00
|
| Rate for Payer: Cigna of CA PPO |
$7,511.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$8,627.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,445.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,030.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$7,612.50
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$6,597.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,627.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,090.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,075.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,075.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,075.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$10,150.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,030.00 |
| Max. Negotiated Rate |
$9,135.00 |
| Rate for Payer: Adventist Health Commercial |
$2,030.00
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,060.00
|
| Rate for Payer: Galaxy Health WC |
$8,627.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,445.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,988.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,030.00
|
| Rate for Payer: Multiplan Commercial |
$7,612.50
|
| Rate for Payer: Networks By Design Commercial |
$6,597.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,627.50
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
OP
|
$10,150.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$9,135.00 |
| Rate for Payer: Adventist Health Commercial |
$4,161.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$743.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,120.00
|
| Rate for Payer: Cigna of CA HMO |
$6,496.00
|
| Rate for Payer: Cigna of CA PPO |
$7,511.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$8,627.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,445.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,030.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$7,612.50
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$6,597.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,627.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,090.00
|
| 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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$10,150.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,030.00 |
| Max. Negotiated Rate |
$9,135.00 |
| Rate for Payer: Adventist Health Commercial |
$2,030.00
|
| Rate for Payer: Cash Price |
$4,567.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,060.00
|
| Rate for Payer: Galaxy Health WC |
$8,627.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,445.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,988.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,030.00
|
| Rate for Payer: Multiplan Commercial |
$7,612.50
|
| Rate for Payer: Networks By Design Commercial |
$6,597.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,627.50
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
IP
|
$3,659.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$731.80 |
| Max. Negotiated Rate |
$3,293.10 |
| Rate for Payer: Adventist Health Commercial |
$731.80
|
| Rate for Payer: Cash Price |
$1,646.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,927.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,561.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,463.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,463.60
|
| Rate for Payer: Galaxy Health WC |
$3,110.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,195.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,293.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,323.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,158.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.80
|
| Rate for Payer: Multiplan Commercial |
$2,744.25
|
| Rate for Payer: Networks By Design Commercial |
$2,378.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,110.15
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
OP
|
$3,659.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$731.80
|
| 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 |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$1,646.55
|
| Rate for Payer: Cash Price |
$1,646.55
|
| Rate for Payer: Cash Price |
$1,646.55
|
| Rate for Payer: Cash Price |
$1,646.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,927.20
|
| Rate for Payer: Cigna of CA HMO |
$2,341.76
|
| Rate for Payer: Cigna of CA PPO |
$2,707.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,561.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$3,110.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,195.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,293.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,323.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,328.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$2,744.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,378.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$3,110.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,115.34
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,195.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,195.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,829.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,829.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,829.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
OP
|
$9,878.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,890.20 |
| Rate for Payer: Adventist Health Commercial |
$1,975.60
|
| 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 |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$4,445.10
|
| Rate for Payer: Cash Price |
$4,445.10
|
| Rate for Payer: Cash Price |
$4,445.10
|
| Rate for Payer: Cash Price |
$4,445.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,902.40
|
| Rate for Payer: Cigna of CA HMO |
$6,321.92
|
| Rate for Payer: Cigna of CA PPO |
$7,309.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,914.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$8,396.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,926.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,890.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,272.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$877.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,975.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$7,408.50
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$6,420.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,396.30
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,926.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,939.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,939.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,939.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
IP
|
$9,878.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,975.60 |
| Max. Negotiated Rate |
$8,890.20 |
| Rate for Payer: Adventist Health Commercial |
$1,975.60
|
| Rate for Payer: Cash Price |
$4,445.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,902.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,914.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,951.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,951.20
|
| Rate for Payer: Galaxy Health WC |
$8,396.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,926.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,890.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,272.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,975.60
|
| Rate for Payer: Multiplan Commercial |
$7,408.50
|
| Rate for Payer: Networks By Design Commercial |
$6,420.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,396.30
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
IP
|
$10,189.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,037.80 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,075.60
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,470.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,011.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
IP
|
$10,189.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,037.80 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,075.60
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,470.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,011.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
OP
|
$10,189.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$4,177.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$789.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: Cigna of CA HMO |
$6,520.96
|
| Rate for Payer: Cigna of CA PPO |
$7,539.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,470.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,113.40
|
| 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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
