|
HC FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$3,602.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$720.40 |
| Max. Negotiated Rate |
$3,241.80 |
| Rate for Payer: Adventist Health Commercial |
$720.40
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,881.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,440.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,440.80
|
| Rate for Payer: Galaxy Health WC |
$3,061.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,161.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,402.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,372.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,229.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.40
|
| Rate for Payer: Multiplan Commercial |
$2,701.50
|
| Rate for Payer: Networks By Design Commercial |
$2,341.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,061.70
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
OP
|
$1,636.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$3,311.29 |
| Rate for Payer: Adventist Health Commercial |
$327.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$993.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,311.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$960.82
|
| Rate for Payer: Blue Shield of California Commercial |
$993.05
|
| Rate for Payer: Blue Shield of California EPN |
$649.49
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,308.80
|
| Rate for Payer: Cigna of CA HMO |
$1,047.04
|
| Rate for Payer: Cigna of CA PPO |
$1,210.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,390.60
|
| Rate for Payer: Global Benefits Group Commercial |
$981.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,472.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,091.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,227.00
|
| Rate for Payer: Networks By Design Commercial |
$1,063.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,390.60
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
IP
|
$3,529.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$705.80 |
| Max. Negotiated Rate |
$3,176.10 |
| Rate for Payer: Adventist Health Commercial |
$705.80
|
| Rate for Payer: Cash Price |
$1,588.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,411.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,411.60
|
| Rate for Payer: Galaxy Health WC |
$2,999.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,117.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,176.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,353.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,344.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,184.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.80
|
| Rate for Payer: Multiplan Commercial |
$2,646.75
|
| Rate for Payer: Networks By Design Commercial |
$2,293.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,999.65
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$2,711.02 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,038.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,711.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,004.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,037.97
|
| Rate for Payer: Blue Shield of California EPN |
$678.87
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,368.00
|
| Rate for Payer: Cigna of CA HMO |
$1,094.40
|
| Rate for Payer: Cigna of CA PPO |
$1,265.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,453.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,539.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$643.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,140.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,282.50
|
| Rate for Payer: Networks By Design Commercial |
$1,111.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,453.50
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,026.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,026.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$590.00 |
| Max. Negotiated Rate |
$2,655.00 |
| Rate for Payer: Adventist Health Commercial |
$590.00
|
| Rate for Payer: Cash Price |
$1,327.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,360.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,180.00
|
| Rate for Payer: Galaxy Health WC |
$2,507.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,770.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,655.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,967.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,826.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.00
|
| Rate for Payer: Multiplan Commercial |
$2,212.50
|
| Rate for Payer: Networks By Design Commercial |
$1,917.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,507.50
|
|
|
HC FNA BX W/CT GDN 1ST LESION
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| 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 |
$1,374.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,666.76
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,816.32
|
| Rate for Payer: Cigna of CA PPO |
$2,100.12
|
| 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 |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$737.05
|
| 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 |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| 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 |
$2,412.30
|
| 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 |
$1,702.80
|
| 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 FNA BX W/CT GDN 1ST LESION
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$2,554.20 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,135.20
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,756.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$1,277.10 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$946.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$540.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$780.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,064.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$687.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$833.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$908.16
|
| Rate for Payer: Cigna of CA PPO |
$1,050.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,206.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,206.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.85
|
| Rate for Payer: InnovAge PACE Commercial |
$709.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$946.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$993.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$993.30
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
| Rate for Payer: Riverside University Health System MISP |
$567.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,206.15
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$2,554.20 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,135.20
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,756.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$446.32 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| 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 |
$1,374.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,666.76
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,816.32
|
| Rate for Payer: Cigna of CA PPO |
$2,100.12
|
| 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 |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.32
|
| 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 |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| 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 |
$2,412.30
|
| 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 |
$1,702.80
|
| 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 FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$1,277.10 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$946.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$540.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
|
|
HC FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.38 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$780.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,064.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$687.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$833.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$908.16
|
| Rate for Payer: Cigna of CA PPO |
$1,050.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,206.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,206.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$250.38
|
| Rate for Payer: InnovAge PACE Commercial |
$709.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$946.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$993.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$993.30
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
| Rate for Payer: Riverside University Health System MISP |
$567.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,206.15
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| 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 |
$1,374.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,666.76
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,816.32
|
| Rate for Payer: Cigna of CA PPO |
$2,100.12
|
| 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 |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| 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 |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| 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 |
$2,412.30
|
| 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 |
$1,702.80
|
| 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 FNA BX W/MR GDN 1ST LESION
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$2,554.20 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,135.20
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,756.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
|
|
HC FNA BX W/MR GDN EA ADDL LSN
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
CPT 10012
|
| Hospital Charge Code |
909010012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$780.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,064.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$687.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$833.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$908.16
|
| Rate for Payer: Cigna of CA PPO |
$1,050.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,206.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,206.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: InnovAge PACE Commercial |
$709.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$946.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$993.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$993.30
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
| Rate for Payer: Riverside University Health System MISP |
$567.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,206.15
|
|
|
HC FNA BX W/MR GDN EA ADDL LSN
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
CPT 10012
|
| Hospital Charge Code |
909010012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$1,277.10 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$946.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$540.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.11 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| 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 |
$1,374.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,666.76
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,816.32
|
| Rate for Payer: Cigna of CA PPO |
$2,100.12
|
| 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 |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$192.11
|
| 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 |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| 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 |
$2,412.30
|
| 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 |
$1,702.80
|
| 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 FNA BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$2,554.20 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,135.20
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,756.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$1,277.10 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$946.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$540.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.01 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$780.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,064.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$687.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$833.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$908.16
|
| Rate for Payer: Cigna of CA PPO |
$1,050.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,206.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,206.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.01
|
| Rate for Payer: InnovAge PACE Commercial |
$709.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$946.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$993.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$993.30
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
| Rate for Payer: Riverside University Health System MISP |
$567.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,206.15
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$92.26
|
| Rate for Payer: Blue Shield of California EPN |
$60.34
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: InnovAge PACE Commercial |
$101.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.89
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Prime Health Services Medicare |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$74.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC FO AS LONG CUST FIT
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
915353040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Blue Shield of California Commercial |
$72.66
|
| Rate for Payer: Blue Shield of California EPN |
$47.38
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
|
|
HC FO AS LONG CUST FIT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
905353040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$15.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.32
|
| Rate for Payer: Blue Shield of California Commercial |
$29.37
|
| Rate for Payer: Blue Shield of California EPN |
$19.15
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$26.60
|
| Rate for Payer: Cigna of CA PPO |
$26.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: InnovAge PACE Commercial |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$19.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Riverside University Health System MISP |
$15.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.26
|
| Rate for Payer: United Healthcare All Other HMO |
$13.88
|
| Rate for Payer: United Healthcare HMO Rider |
$13.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
