|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
OP
|
$3,520.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.26 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: Cigna of CA HMO |
$2,252.80
|
| Rate for Payer: Cigna of CA PPO |
$2,604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$250.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
IP
|
$3,520.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$704.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,408.00
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,341.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,178.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
IP
|
$3,520.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$704.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,408.00
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,341.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,178.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
OP
|
$3,520.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.45 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: Cigna of CA HMO |
$2,252.80
|
| Rate for Payer: Cigna of CA PPO |
$2,604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,760.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,760.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,760.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,760.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$5,311.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
905501287
|
|
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 |
$1,760.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,560.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,980.80
|
| 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 BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$640.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,600.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,600.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,600.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,600.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
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 |
$1,760.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,560.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,980.80
|
| 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 BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Adventist Health Commercial |
$640.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,560.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,980.80
|
| 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 BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$640.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Adventist Health Commercial |
$640.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,560.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,980.80
|
| 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 BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
905501287
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$5,311.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$640.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
IP
|
$3,520.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$704.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,408.00
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,341.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,178.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
IP
|
$3,520.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$704.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,408.00
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,341.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,178.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
OP
|
$3,520.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$307.57 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: Cigna of CA HMO |
$2,252.80
|
| Rate for Payer: Cigna of CA PPO |
$2,604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,760.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,760.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,760.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,760.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
OP
|
$3,520.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$307.57 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$1,443.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: Cigna of CA HMO |
$2,252.80
|
| Rate for Payer: Cigna of CA PPO |
$2,604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,112.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,112.00
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC EXC FACIAL LESION 1.1-2.0 CM
|
Facility
|
OP
|
$4,640.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.67 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$928.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,712.00
|
| Rate for Payer: Cigna of CA HMO |
$2,969.60
|
| Rate for Payer: Cigna of CA PPO |
$3,433.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$3,944.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,784.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,176.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,094.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$3,480.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$3,016.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$3,944.00
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,784.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC EXC FACIAL LESION 1.1-2.0 CM
|
Facility
|
IP
|
$4,640.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$928.00 |
| Max. Negotiated Rate |
$4,176.00 |
| Rate for Payer: Adventist Health Commercial |
$928.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,712.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,856.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,856.00
|
| Rate for Payer: Galaxy Health WC |
$3,944.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,784.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,176.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,094.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,767.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,872.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.00
|
| Rate for Payer: Multiplan Commercial |
$3,480.00
|
| Rate for Payer: Networks By Design Commercial |
$3,016.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,944.00
|
|
|
HC EXC FACIAL LESION 1.1-2.0 CM
|
Facility
|
OP
|
$4,640.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$152.08 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,902.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,712.00
|
| Rate for Payer: Cigna of CA HMO |
$2,969.60
|
| Rate for Payer: Cigna of CA PPO |
$3,433.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$3,944.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,784.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,176.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,094.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$3,480.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$3,016.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$3,944.00
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,784.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,784.00
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC EXC FACIAL LESION 1.1-2.0 CM
|
Facility
|
IP
|
$4,640.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$928.00 |
| Max. Negotiated Rate |
$4,176.00 |
| Rate for Payer: Adventist Health Commercial |
$928.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,712.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,856.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,856.00
|
| Rate for Payer: Galaxy Health WC |
$3,944.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,784.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,176.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,094.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,767.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,872.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.00
|
| Rate for Payer: Multiplan Commercial |
$3,480.00
|
| Rate for Payer: Networks By Design Commercial |
$3,016.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,944.00
|
|
|
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 |
$1,760.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,560.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,980.80
|
| 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 |
$6,248.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC 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 |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| 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 Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| 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 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 |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.19
|
| 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 |
$176.19
|
| Rate for Payer: Blue Shield of California Commercial |
$183.30
|
| Rate for Payer: Blue Shield of California EPN |
$119.70
|
| Rate for Payer: Cash Price |
$165.00
|
| 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: 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: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$1,109.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,613.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,345.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,248.52
|
| 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
|
|
