|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$2,607.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$521.40 |
| Max. Negotiated Rate |
$2,346.30 |
| Rate for Payer: Adventist Health Commercial |
$521.40
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,085.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,824.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,042.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,042.80
|
| Rate for Payer: Galaxy Health WC |
$2,215.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,564.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,346.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,655.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,538.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.40
|
| Rate for Payer: Multiplan Commercial |
$1,955.25
|
| Rate for Payer: Networks By Design Commercial |
$1,694.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,215.95
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$2,607.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,068.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$603.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,085.60
|
| Rate for Payer: Cigna of CA HMO |
$1,668.48
|
| Rate for Payer: Cigna of CA PPO |
$1,929.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,824.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,215.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,564.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,346.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,655.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,955.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,694.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,215.95
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,564.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,564.20
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$2,607.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$521.40
|
| 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 |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,085.60
|
| Rate for Payer: Cigna of CA HMO |
$1,668.48
|
| Rate for Payer: Cigna of CA PPO |
$1,929.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,824.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,215.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,564.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,346.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,655.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,955.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,694.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,215.95
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,564.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,303.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,303.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,303.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,303.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$2,607.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$521.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$603.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,652.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,040.19
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,085.60
|
| Rate for Payer: Cigna of CA HMO |
$1,668.48
|
| Rate for Payer: Cigna of CA PPO |
$1,929.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,824.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,215.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,564.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,346.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,655.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,955.25
|
| Rate for Payer: Networks By Design Commercial |
$1,694.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,215.95
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,564.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,564.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$2,607.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$521.40 |
| Max. Negotiated Rate |
$2,346.30 |
| Rate for Payer: Adventist Health Commercial |
$521.40
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,085.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,824.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,042.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,042.80
|
| Rate for Payer: Galaxy Health WC |
$2,215.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,564.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,346.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,655.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,538.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.40
|
| Rate for Payer: Multiplan Commercial |
$1,955.25
|
| Rate for Payer: Networks By Design Commercial |
$1,694.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,215.95
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$2,607.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$521.40 |
| Max. Negotiated Rate |
$2,346.30 |
| Rate for Payer: Adventist Health Commercial |
$521.40
|
| Rate for Payer: Cash Price |
$1,173.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,085.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,824.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,042.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,042.80
|
| Rate for Payer: Galaxy Health WC |
$2,215.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,564.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,346.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,655.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,538.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.40
|
| Rate for Payer: Multiplan Commercial |
$1,955.25
|
| Rate for Payer: Networks By Design Commercial |
$1,694.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,215.95
|
|
|
HC INC OF CONJUNCTIVA, DRNG OF CYST
|
Facility
|
IP
|
$3,077.00
|
|
|
Service Code
|
CPT 68020
|
| Hospital Charge Code |
900501900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$615.40 |
| Max. Negotiated Rate |
$2,769.30 |
| Rate for Payer: Adventist Health Commercial |
$615.40
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,461.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,153.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,230.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,230.80
|
| Rate for Payer: Galaxy Health WC |
$2,615.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,846.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,769.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,953.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,815.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.40
|
| Rate for Payer: Multiplan Commercial |
$2,307.75
|
| Rate for Payer: Networks By Design Commercial |
$2,000.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,615.45
|
|
|
HC INC OF CONJUNCTIVA, DRNG OF CYST
|
Facility
|
OP
|
$3,077.00
|
|
|
Service Code
|
CPT 68020
|
| Hospital Charge Code |
900501900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$615.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,282.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,960.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,461.60
|
| Rate for Payer: Cigna of CA HMO |
$1,969.28
|
| Rate for Payer: Cigna of CA PPO |
$2,276.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,153.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,115.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1,410.37
|
| Rate for Payer: Galaxy Health WC |
$2,615.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,846.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,769.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,102.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$218.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,953.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,795.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,718.08
|
| Rate for Payer: Multiplan Commercial |
$2,307.75
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$2,000.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Preferred Health Network WC |
$2,000.79
|
| Rate for Payer: Prime Health Services Commercial |
$2,615.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,359.08
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Riverside University Health System MISP |
$1,410.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,846.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,538.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,282.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
OP
|
$10,859.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,773.10 |
| Rate for Payer: Adventist Health Commercial |
$2,171.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Cash Price |
$4,886.55
|
| Rate for Payer: Cash Price |
$4,886.55
|
| Rate for Payer: Cash Price |
$4,886.55
|
| Rate for Payer: Cash Price |
$4,886.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,687.20
|
| Rate for Payer: Cigna of CA HMO |
$6,949.76
|
| Rate for Payer: Cigna of CA PPO |
$8,035.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$9,230.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,773.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,895.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$462.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,171.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$8,144.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$7,058.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$9,230.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,429.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,429.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,429.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,429.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
IP
|
$10,859.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,171.80 |
| Max. Negotiated Rate |
$9,773.10 |
| Rate for Payer: Adventist Health Commercial |
$2,171.80
|
| Rate for Payer: Cash Price |
$4,886.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,687.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,343.60
|
| Rate for Payer: Galaxy Health WC |
$9,230.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,773.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,895.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,406.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,171.80
|
| Rate for Payer: Multiplan Commercial |
$8,144.25
|
| Rate for Payer: Networks By Design Commercial |
$7,058.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,230.15
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
IP
|
$2,437.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$487.40 |
| Max. Negotiated Rate |
$2,193.30 |
| Rate for Payer: Adventist Health Commercial |
$487.40
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,949.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,705.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.80
|
| Rate for Payer: EPIC Health Plan Senior |
$974.80
|
| Rate for Payer: Galaxy Health WC |
$2,071.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,462.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,193.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,547.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,437.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.40
|
| Rate for Payer: Multiplan Commercial |
$1,827.75
|
| Rate for Payer: Networks By Design Commercial |
$1,584.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,071.45
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
OP
|
$2,437.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$98.33 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$999.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$508.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,949.60
|
| Rate for Payer: Cigna of CA HMO |
$1,559.68
|
| Rate for Payer: Cigna of CA PPO |
$1,803.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,705.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,071.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,462.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,193.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,547.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,827.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,584.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,071.45
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,462.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,462.20
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
IP
|
$2,437.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$487.40 |
| Max. Negotiated Rate |
$2,193.30 |
| Rate for Payer: Adventist Health Commercial |
$487.40
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,949.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,705.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.80
|
| Rate for Payer: EPIC Health Plan Senior |
$974.80
|
| Rate for Payer: Galaxy Health WC |
$2,071.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,462.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,193.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,547.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,437.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.40
|
| Rate for Payer: Multiplan Commercial |
$1,827.75
|
| Rate for Payer: Networks By Design Commercial |
$1,584.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,071.45
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
OP
|
$2,437.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.33 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$487.40
|
| 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 |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,949.60
|
| Rate for Payer: Cigna of CA HMO |
$1,559.68
|
| Rate for Payer: Cigna of CA PPO |
$1,803.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,705.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,071.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,462.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,193.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,547.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,827.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,584.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,071.45
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,462.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,218.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,218.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,218.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,218.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$769.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.93 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$153.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Central Health Plan Commercial |
$615.20
|
| Rate for Payer: Cigna of CA HMO |
$492.16
|
| Rate for Payer: Cigna of CA PPO |
$569.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$653.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$538.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$307.60
|
| Rate for Payer: Galaxy Health WC |
$653.65
|
| Rate for Payer: Global Benefits Group Commercial |
$461.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$114.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$126.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$538.30
|
| Rate for Payer: Multiplan Commercial |
$576.75
|
| Rate for Payer: Networks By Design Commercial |
$499.85
|
| Rate for Payer: Prime Health Services Commercial |
$653.65
|
| Rate for Payer: Riverside University Health System MISP |
$307.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.65
|
| Rate for Payer: Vantage Medical Group Senior |
$653.65
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$769.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.80 |
| Max. Negotiated Rate |
$692.10 |
| Rate for Payer: Adventist Health Commercial |
$153.80
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Central Health Plan Commercial |
$615.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$538.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$307.60
|
| Rate for Payer: Galaxy Health WC |
$653.65
|
| Rate for Payer: Global Benefits Group Commercial |
$461.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.80
|
| Rate for Payer: Multiplan Commercial |
$576.75
|
| Rate for Payer: Networks By Design Commercial |
$499.85
|
| Rate for Payer: Prime Health Services Commercial |
$653.65
|
|
|
HC IND ABTN GT 1 IA INJ INCL HA
|
Facility
|
IP
|
$12,334.00
|
|
|
Service Code
|
CPT 59850
|
| Hospital Charge Code |
909009850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,466.80 |
| Max. Negotiated Rate |
$11,100.60 |
| Rate for Payer: Adventist Health Commercial |
$2,466.80
|
| Rate for Payer: Cash Price |
$5,550.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,867.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,633.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,933.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,933.60
|
| Rate for Payer: Galaxy Health WC |
$10,483.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,400.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,100.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,832.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,277.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,466.80
|
| Rate for Payer: Multiplan Commercial |
$9,250.50
|
| Rate for Payer: Networks By Design Commercial |
$8,017.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,483.90
|
|
|
HC IND ABTN GT 1 IA INJ INCL HA
|
Facility
|
OP
|
$12,334.00
|
|
|
Service Code
|
CPT 59850
|
| Hospital Charge Code |
909009850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.26 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,466.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,483.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,783.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,250.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,550.30
|
| Rate for Payer: Cash Price |
$5,550.30
|
| Rate for Payer: Cash Price |
$5,550.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,867.20
|
| Rate for Payer: Cigna of CA HMO |
$7,893.76
|
| Rate for Payer: Cigna of CA PPO |
$9,127.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,483.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,483.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,483.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,633.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,933.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,933.60
|
| Rate for Payer: Galaxy Health WC |
$10,483.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,400.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,100.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$564.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,832.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,277.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,466.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,633.80
|
| Rate for Payer: Multiplan Commercial |
$9,250.50
|
| Rate for Payer: Networks By Design Commercial |
$8,017.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,483.90
|
| Rate for Payer: Riverside University Health System MISP |
$4,933.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,400.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,167.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$10,483.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,483.90
|
| Rate for Payer: Vantage Medical Group Senior |
$10,483.90
|
|
|
HC INDIV BRIEF THERAPY
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$248.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$230.69
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC INDIV BRIEF THERAPY
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$464.17 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$464.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.44
|
| Rate for Payer: Blue Shield of California Commercial |
$247.89
|
| Rate for Payer: Blue Shield of California EPN |
$156.01
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$248.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC INDIV THERAPY
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804007
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.44
|
| Rate for Payer: Blue Shield of California Commercial |
$247.89
|
| Rate for Payer: Blue Shield of California EPN |
$156.01
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$248.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC INDIV THERAPY
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804007
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$248.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$230.69
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC INDR ARROW FLEX 24 CM
|
Facility
|
OP
|
$71.42
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$364.83 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$364.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.55
|
| Rate for Payer: Blue Shield of California Commercial |
$45.28
|
| Rate for Payer: Blue Shield of California EPN |
$28.50
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: Cigna of CA HMO |
$45.71
|
| Rate for Payer: Cigna of CA PPO |
$52.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.99
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
| Rate for Payer: Riverside University Health System MISP |
$28.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.71
|
| Rate for Payer: United Healthcare All Other HMO |
$35.71
|
| Rate for Payer: United Healthcare HMO Rider |
$35.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.71
|
| Rate for Payer: Vantage Medical Group Senior |
$60.71
|
|
|
HC INDR ARROW FLEX 24 CM
|
Facility
|
IP
|
$71.42
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
|
|
HC INDR BIO/WEB PREFACE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$364.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$256.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.72
|
| Rate for Payer: Blue Shield of California Commercial |
$335.39
|
| Rate for Payer: Blue Shield of California EPN |
$211.07
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Riverside University Health System MISP |
$211.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
