|
HC EX MALIGNANT LES GT 4.0 CM
|
Facility
|
OP
|
$8,074.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
900501793
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$390.61 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: Cigna of CA HMO |
$5,167.36
|
| Rate for Payer: Cigna of CA PPO |
$5,974.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$390.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,385.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,844.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC EX MALIGNANT LES GT 4.0 CM
|
Facility
|
IP
|
$8,074.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
900501793
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,614.80 |
| Max. Negotiated Rate |
$7,266.60 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,229.60
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,385.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,076.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,997.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
|
|
HC EX MALIGNANT LES INC MARGINS 0.6 - 1.0 CM
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
900501795
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.08 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| 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 |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| 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 |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.08
|
| 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 |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| 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 |
$2,486.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| 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 |
$2,817.75
|
| 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 |
$1,989.00
|
| 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 EX MALIGNANT LES INC MARGINS 0.6 - 1.0 CM
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
900501795
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC EX MALIGNANT LES INC MARGINS 2.1 - 3.0 CM
|
Facility
|
OP
|
$4,202.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
900501796
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.05 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$840.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$3,280.13
|
| 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 |
$1,890.90
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,361.60
|
| Rate for Payer: Cigna of CA HMO |
$2,689.28
|
| Rate for Payer: Cigna of CA PPO |
$3,109.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,571.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,521.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,781.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,802.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$3,151.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,731.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,571.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,521.20
|
| 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 |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC EX MALIGNANT LES INC MARGINS 2.1 - 3.0 CM
|
Facility
|
IP
|
$4,202.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
900501796
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$3,781.80 |
| Rate for Payer: Adventist Health Commercial |
$840.40
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,361.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,680.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,680.80
|
| Rate for Payer: Galaxy Health WC |
$3,571.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,521.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,781.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,802.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,600.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,601.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.40
|
| Rate for Payer: Multiplan Commercial |
$3,151.50
|
| Rate for Payer: Networks By Design Commercial |
$2,731.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,571.70
|
|
|
HC EX MALIGNANT LES INC MARGINS LT 0.5 CM
|
Facility
|
IP
|
$2,422.00
|
|
|
Service Code
|
CPT 11620
|
| Hospital Charge Code |
900501794
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.40 |
| Max. Negotiated Rate |
$2,179.80 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,937.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.80
|
| Rate for Payer: EPIC Health Plan Senior |
$968.80
|
| Rate for Payer: Galaxy Health WC |
$2,058.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,179.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,615.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,499.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.40
|
| Rate for Payer: Multiplan Commercial |
$1,816.50
|
| Rate for Payer: Networks By Design Commercial |
$1,574.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,058.70
|
|
|
HC EX MALIGNANT LES INC MARGINS LT 0.5 CM
|
Facility
|
OP
|
$2,422.00
|
|
|
Service Code
|
CPT 11620
|
| Hospital Charge Code |
900501794
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.36 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$3,280.13
|
| 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 |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,937.60
|
| Rate for Payer: Cigna of CA HMO |
$1,550.08
|
| Rate for Payer: Cigna of CA PPO |
$1,792.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$2,058.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,179.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,615.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$1,816.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,574.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$2,058.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,453.20
|
| 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 |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC EX OF NAIL & MAT PART OR COMP
|
Facility
|
OP
|
$2,010.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.41 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$402.00
|
| 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 |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,608.00
|
| Rate for Payer: Cigna of CA HMO |
$1,286.40
|
| Rate for Payer: Cigna of CA PPO |
$1,487.40
|
| 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 |
$1,708.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,206.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,809.00
|
| 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 |
$1,340.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| 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 |
$1,507.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,306.50
|
| 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 |
$1,708.50
|
| 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 |
$1,206.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,005.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,005.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,005.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,005.00
|
| 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 EX OF NAIL & MAT PART OR COMP
|
Facility
|
IP
|
$2,010.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$402.00 |
| Max. Negotiated Rate |
$1,809.00 |
| Rate for Payer: Adventist Health Commercial |
$402.00
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,608.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$804.00
|
| Rate for Payer: EPIC Health Plan Senior |
$804.00
|
| Rate for Payer: Galaxy Health WC |
$1,708.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,206.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,809.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,244.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$1,507.50
|
| Rate for Payer: Networks By Design Commercial |
$1,306.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,708.50
|
|
|
HC EX OF NAIL & MAT PART OR COMP
|
Facility
|
IP
|
$2,010.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$402.00 |
| Max. Negotiated Rate |
$1,809.00 |
| Rate for Payer: Adventist Health Commercial |
$402.00
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,608.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$804.00
|
| Rate for Payer: EPIC Health Plan Senior |
$804.00
|
| Rate for Payer: Galaxy Health WC |
$1,708.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,206.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,809.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,244.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$1,507.50
|
| Rate for Payer: Networks By Design Commercial |
$1,306.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,708.50
|
|
|
HC EX OF NAIL & MAT PART OR COMP
|
Facility
|
OP
|
$2,010.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$281.41 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$824.10
|
| 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 |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,608.00
|
| Rate for Payer: Cigna of CA HMO |
$1,286.40
|
| Rate for Payer: Cigna of CA PPO |
$1,487.40
|
| 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 |
$1,708.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,206.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,809.00
|
| 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 |
$1,340.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| 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 |
$1,507.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,306.50
|
| 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 |
$1,708.50
|
| 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 |
$1,206.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,206.00
|
| 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 |
$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 EXPIRED CARBON DIOXIDE DETERM
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 94770
|
| Hospital Charge Code |
900800104
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$133.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$566.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$366.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$500.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$322.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.73
|
| Rate for Payer: Blue Shield of California Commercial |
$404.87
|
| Rate for Payer: Blue Shield of California EPN |
$264.80
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: Cigna of CA HMO |
$426.88
|
| Rate for Payer: Cigna of CA PPO |
$493.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$566.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$566.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$266.80
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| Rate for Payer: InnovAge PACE Commercial |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$412.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.90
|
| Rate for Payer: Multiplan Commercial |
$500.25
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
| Rate for Payer: Riverside University Health System MISP |
$266.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$566.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.95
|
| Rate for Payer: Vantage Medical Group Senior |
$566.95
|
|
|
HC EXPIRED CARBON DIOXIDE DETERM
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 94770
|
| Hospital Charge Code |
900800104
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$600.30 |
| Rate for Payer: Adventist Health Commercial |
$133.40
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$266.80
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$412.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| Rate for Payer: Multiplan Commercial |
$500.25
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
|
|
HC EXPIRED CO2 DETERM
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800910
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$92.20 |
| Max. Negotiated Rate |
$414.90 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Central Health Plan Commercial |
$368.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.40
|
| Rate for Payer: EPIC Health Plan Senior |
$184.40
|
| Rate for Payer: Galaxy Health WC |
$391.85
|
| Rate for Payer: Global Benefits Group Commercial |
$276.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$307.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$285.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.20
|
| Rate for Payer: Multiplan Commercial |
$345.75
|
| Rate for Payer: Networks By Design Commercial |
$299.65
|
| Rate for Payer: Prime Health Services Commercial |
$391.85
|
|
|
HC EXPIRED CO2 DETERM
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800910
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$92.20 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$223.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.75
|
| Rate for Payer: Blue Shield of California Commercial |
$279.83
|
| Rate for Payer: Blue Shield of California EPN |
$183.02
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Central Health Plan Commercial |
$368.80
|
| Rate for Payer: Cigna of CA HMO |
$295.04
|
| Rate for Payer: Cigna of CA PPO |
$341.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$391.85
|
| Rate for Payer: Global Benefits Group Commercial |
$276.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$307.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$345.75
|
| Rate for Payer: Networks By Design Commercial |
$299.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$391.85
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
OP
|
$2,882.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$576.40
|
| 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 |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| 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 |
$1,030.97
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,305.60
|
| Rate for Payer: Cigna of CA HMO |
$1,844.48
|
| Rate for Payer: Cigna of CA PPO |
$2,132.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,593.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$2,161.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,729.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,441.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,441.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,441.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
IP
|
$2,882.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.40 |
| Max. Negotiated Rate |
$2,593.80 |
| Rate for Payer: Adventist Health Commercial |
$576.40
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,152.80
|
| Rate for Payer: Galaxy Health WC |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,593.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,783.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.40
|
| Rate for Payer: Multiplan Commercial |
$2,161.50
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
IP
|
$2,882.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$576.40 |
| Max. Negotiated Rate |
$2,593.80 |
| Rate for Payer: Adventist Health Commercial |
$576.40
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,152.80
|
| Rate for Payer: Galaxy Health WC |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,593.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,783.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.40
|
| Rate for Payer: Multiplan Commercial |
$2,161.50
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
OP
|
$2,882.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,181.62
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,750.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| 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 |
$1,030.97
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,305.60
|
| Rate for Payer: Cigna of CA HMO |
$1,844.48
|
| Rate for Payer: Cigna of CA PPO |
$2,132.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,593.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$2,161.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,729.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,729.20
|
| 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 |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC EXPLORE KNEE I & D W/F.B. RMVL
|
Facility
|
IP
|
$16,291.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,258.20 |
| Max. Negotiated Rate |
$14,661.90 |
| Rate for Payer: Adventist Health Commercial |
$3,258.20
|
| Rate for Payer: Cash Price |
$7,330.95
|
| Rate for Payer: Central Health Plan Commercial |
$13,032.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,516.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,516.40
|
| Rate for Payer: Galaxy Health WC |
$13,847.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,774.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,661.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,866.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,206.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,084.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,258.20
|
| Rate for Payer: Multiplan Commercial |
$12,218.25
|
| Rate for Payer: Networks By Design Commercial |
$10,589.15
|
| Rate for Payer: Prime Health Services Commercial |
$13,847.35
|
|
|
HC EXPLORE KNEE I & D W/F.B. RMVL
|
Facility
|
OP
|
$16,291.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,661.90 |
| Rate for Payer: Adventist Health Commercial |
$3,258.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$7,330.95
|
| Rate for Payer: Cash Price |
$7,330.95
|
| Rate for Payer: Cash Price |
$7,330.95
|
| Rate for Payer: Cash Price |
$7,330.95
|
| Rate for Payer: Central Health Plan Commercial |
$13,032.80
|
| Rate for Payer: Cigna of CA HMO |
$10,426.24
|
| Rate for Payer: Cigna of CA PPO |
$12,055.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$13,847.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,774.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,661.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,866.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,258.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$12,218.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$10,589.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$13,847.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,774.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,145.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,145.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,145.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,145.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC EXPLORE LIMB VESSELS
|
Facility
|
OP
|
$5,764.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,611.20
|
| Rate for Payer: Cigna of CA HMO |
$3,688.96
|
| Rate for Payer: Cigna of CA PPO |
$4,265.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,899.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,187.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,844.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,323.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,746.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$4,899.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,882.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,882.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,882.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC EXPLORE LIMB VESSELS
|
Facility
|
IP
|
$5,764.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,152.80 |
| Max. Negotiated Rate |
$5,187.60 |
| Rate for Payer: Adventist Health Commercial |
$1,152.80
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,611.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,305.60
|
| Rate for Payer: Galaxy Health WC |
$4,899.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,187.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,844.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,196.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,567.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,152.80
|
| Rate for Payer: Multiplan Commercial |
$4,323.00
|
| Rate for Payer: Networks By Design Commercial |
$3,746.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,899.40
|
|
|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
IP
|
$8,829.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,765.80 |
| Max. Negotiated Rate |
$7,946.10 |
| Rate for Payer: Adventist Health Commercial |
$1,765.80
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,063.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,531.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,531.60
|
| Rate for Payer: Galaxy Health WC |
$7,504.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,297.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,946.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,888.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,363.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,465.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,765.80
|
| Rate for Payer: Multiplan Commercial |
$6,621.75
|
| Rate for Payer: Networks By Design Commercial |
$5,738.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,504.65
|
|
