|
HC IDENT OF ARTHROPOD
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC IDENT OF ARTHROPOD
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$13.96
|
| Rate for Payer: Blue Shield of California EPN |
$9.13
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC IDENT OF PARASITES
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC IDENT OF PARASITES
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$4.31
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: InnovAge PACE Commercial |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.31
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$4.57
|
| Rate for Payer: Riverside University Health System MISP |
$4.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$1,242.90 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,242.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.20
|
| Rate for Payer: Multiplan Commercial |
$1,035.75
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$566.21
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$811.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,104.80
|
| Rate for Payer: Cigna of CA HMO |
$883.84
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| 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 |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,242.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.20
|
| 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 |
$1,035.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| 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 |
$1,173.85
|
| 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 |
$828.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$828.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$1,242.90 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,242.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.20
|
| Rate for Payer: Multiplan Commercial |
$1,035.75
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,104.80
|
| Rate for Payer: Cigna of CA HMO |
$883.84
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| 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 |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,242.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.20
|
| 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 |
$1,035.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| 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 |
$1,173.85
|
| 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 |
$828.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$690.50
|
| Rate for Payer: United Healthcare All Other HMO |
$690.50
|
| Rate for Payer: United Healthcare HMO Rider |
$690.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$690.50
|
| 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 I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$6,568.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$85.81 |
| Max. Negotiated Rate |
$5,911.20 |
| Rate for Payer: Adventist Health Commercial |
$1,313.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,013.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,620.63
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,254.40
|
| Rate for Payer: Cigna of CA HMO |
$4,203.52
|
| Rate for Payer: Cigna of CA PPO |
$4,860.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,582.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,911.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,926.00
|
| Rate for Payer: Networks By Design Commercial |
$4,269.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Prime Health Services Commercial |
$5,582.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,940.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,940.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,284.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,284.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,284.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,284.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$6,568.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,313.60 |
| Max. Negotiated Rate |
$5,911.20 |
| Rate for Payer: Adventist Health Commercial |
$1,313.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,254.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,627.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,627.20
|
| Rate for Payer: Galaxy Health WC |
$5,582.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,911.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,502.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,065.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.60
|
| Rate for Payer: Multiplan Commercial |
$4,926.00
|
| Rate for Payer: Networks By Design Commercial |
$4,269.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,582.80
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$6,568.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,313.60 |
| Max. Negotiated Rate |
$5,911.20 |
| Rate for Payer: Adventist Health Commercial |
$1,313.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,254.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,627.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,627.20
|
| Rate for Payer: Galaxy Health WC |
$5,582.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,911.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,502.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,065.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.60
|
| Rate for Payer: Multiplan Commercial |
$4,926.00
|
| Rate for Payer: Networks By Design Commercial |
$4,269.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,582.80
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$6,568.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.81 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,313.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,254.40
|
| Rate for Payer: Cigna of CA HMO |
$4,203.52
|
| Rate for Payer: Cigna of CA PPO |
$4,860.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,582.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,911.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,926.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,269.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,582.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,940.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$6,568.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$5,911.20 |
| Rate for Payer: Adventist Health Commercial |
$1,313.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,254.40
|
| Rate for Payer: Cigna of CA HMO |
$4,203.52
|
| Rate for Payer: Cigna of CA PPO |
$4,860.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,582.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,911.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,926.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,269.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,582.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,940.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,284.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,284.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,284.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,284.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$6,568.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$85.81 |
| Max. Negotiated Rate |
$5,911.20 |
| Rate for Payer: Adventist Health Commercial |
$1,313.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,013.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,620.63
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,254.40
|
| Rate for Payer: Cigna of CA HMO |
$4,203.52
|
| Rate for Payer: Cigna of CA PPO |
$4,860.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,582.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,911.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,926.00
|
| Rate for Payer: Networks By Design Commercial |
$4,269.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Prime Health Services Commercial |
$5,582.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,940.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,940.80
|
| 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 |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$6,568.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,313.60 |
| Max. Negotiated Rate |
$5,911.20 |
| Rate for Payer: Adventist Health Commercial |
$1,313.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,254.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,627.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,627.20
|
| Rate for Payer: Galaxy Health WC |
$5,582.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,911.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,502.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,065.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.60
|
| Rate for Payer: Multiplan Commercial |
$4,926.00
|
| Rate for Payer: Networks By Design Commercial |
$4,269.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,582.80
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$6,568.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$1,313.60 |
| Max. Negotiated Rate |
$5,911.20 |
| Rate for Payer: Adventist Health Commercial |
$1,313.60
|
| Rate for Payer: Cash Price |
$2,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,254.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,627.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,627.20
|
| Rate for Payer: Galaxy Health WC |
$5,582.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,911.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,502.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,065.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.60
|
| Rate for Payer: Multiplan Commercial |
$4,926.00
|
| Rate for Payer: Networks By Design Commercial |
$4,269.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,582.80
|
|
|
HC I & D LACRIMAL SAC
|
Facility
|
OP
|
$8,647.00
|
|
|
Service Code
|
CPT 68420
|
| Hospital Charge Code |
902890372
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$379.87 |
| Max. Negotiated Rate |
$7,782.30 |
| Rate for Payer: Adventist Health Commercial |
$3,545.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$3,891.15
|
| Rate for Payer: Cash Price |
$3,891.15
|
| Rate for Payer: Cash Price |
$3,891.15
|
| Rate for Payer: Cash Price |
$3,891.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,917.60
|
| Rate for Payer: Cigna of CA HMO |
$5,534.08
|
| Rate for Payer: Cigna of CA PPO |
$6,398.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$7,349.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,188.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,782.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: InnovAge PACE Commercial |
$4,446.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,767.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,972.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$6,485.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$5,620.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,349.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,142.12
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,260.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,188.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,188.20
|
| 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 |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC I & D LACRIMAL SAC
|
Facility
|
IP
|
$8,647.00
|
|
|
Service Code
|
CPT 68420
|
| Hospital Charge Code |
902890372
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,729.40 |
| Max. Negotiated Rate |
$7,782.30 |
| Rate for Payer: Adventist Health Commercial |
$1,729.40
|
| Rate for Payer: Cash Price |
$3,891.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,458.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,458.80
|
| Rate for Payer: Galaxy Health WC |
$7,349.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,188.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,782.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,767.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,294.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,352.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.40
|
| Rate for Payer: Multiplan Commercial |
$6,485.25
|
| Rate for Payer: Networks By Design Commercial |
$5,620.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,349.95
|
|
|
HC I&D OF MTH LSN;MSTCTR SPACE
|
Facility
|
OP
|
$6,263.00
|
|
|
Service Code
|
CPT 41018
|
| Hospital Charge Code |
900541018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,636.70 |
| Rate for Payer: Adventist Health Commercial |
$1,252.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$2,818.35
|
| Rate for Payer: Cash Price |
$2,818.35
|
| Rate for Payer: Cash Price |
$2,818.35
|
| Rate for Payer: Cash Price |
$2,818.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,010.40
|
| Rate for Payer: Cigna of CA HMO |
$4,008.32
|
| Rate for Payer: Cigna of CA PPO |
$4,634.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$5,323.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,636.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,252.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$4,697.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$4,070.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$5,323.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,995.04
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,131.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,131.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,131.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,131.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC I&D OF MTH LSN;MSTCTR SPACE
|
Facility
|
IP
|
$6,263.00
|
|
|
Service Code
|
CPT 41018
|
| Hospital Charge Code |
900541018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,252.60 |
| Max. Negotiated Rate |
$5,636.70 |
| Rate for Payer: Adventist Health Commercial |
$1,252.60
|
| Rate for Payer: Cash Price |
$2,818.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,505.20
|
| Rate for Payer: Galaxy Health WC |
$5,323.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,636.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,386.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,876.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,252.60
|
| Rate for Payer: Multiplan Commercial |
$4,697.25
|
| Rate for Payer: Networks By Design Commercial |
$4,070.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,323.55
|
|
|
HC I & D OF SCROTUM
|
Facility
|
IP
|
$9,845.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,969.00 |
| Max. Negotiated Rate |
$8,860.50 |
| Rate for Payer: Adventist Health Commercial |
$1,969.00
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,938.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,938.00
|
| Rate for Payer: Galaxy Health WC |
$8,368.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,860.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,566.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,750.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,094.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Multiplan Commercial |
$7,383.75
|
| Rate for Payer: Networks By Design Commercial |
$6,399.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,368.25
|
|
|
HC I & D OF SCROTUM
|
Facility
|
IP
|
$9,845.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,969.00 |
| Max. Negotiated Rate |
$8,860.50 |
| Rate for Payer: Adventist Health Commercial |
$1,969.00
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,938.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,938.00
|
| Rate for Payer: Galaxy Health WC |
$8,368.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,860.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,566.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,750.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,094.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Multiplan Commercial |
$7,383.75
|
| Rate for Payer: Networks By Design Commercial |
$6,399.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,368.25
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$9,845.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$377.04 |
| Max. Negotiated Rate |
$8,860.50 |
| Rate for Payer: Adventist Health Commercial |
$4,036.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,876.00
|
| Rate for Payer: Cigna of CA HMO |
$6,300.80
|
| Rate for Payer: Cigna of CA PPO |
$7,285.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$8,368.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,860.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,566.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$7,383.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$6,399.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$8,368.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,907.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,907.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$9,845.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$377.04 |
| Max. Negotiated Rate |
$8,860.50 |
| Rate for Payer: Adventist Health Commercial |
$1,969.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,876.00
|
| Rate for Payer: Cigna of CA HMO |
$6,300.80
|
| Rate for Payer: Cigna of CA PPO |
$7,285.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$8,368.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,860.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,566.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$7,383.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$6,399.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$8,368.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,907.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,922.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,922.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,922.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,922.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,431.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Senior |
$636.00
|
| Rate for Payer: Galaxy Health WC |
$1,351.50
|
| Rate for Payer: Global Benefits Group Commercial |
$954.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,431.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,060.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$984.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.00
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Networks By Design Commercial |
$1,033.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,351.50
|
|
