|
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 |
$759.55
|
| 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 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 |
$3,612.40
|
| 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 |
$3,612.40
|
| 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
|
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 |
$3,612.40
|
| Rate for Payer: Cash Price |
$3,612.40
|
| Rate for Payer: Cash Price |
$3,612.40
|
| 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
|
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 |
$3,612.40
|
| Rate for Payer: Cash Price |
$3,612.40
|
| Rate for Payer: Cash Price |
$3,612.40
|
| Rate for Payer: Cash Price |
$3,612.40
|
| 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
|
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 |
$3,612.40
|
| 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 |
$3,612.40
|
| 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
|
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 |
$3,612.40
|
| Rate for Payer: Cash Price |
$3,612.40
|
| Rate for Payer: Cash Price |
$3,612.40
|
| 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
|
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 |
$3,612.40
|
| Rate for Payer: Cash Price |
$3,612.40
|
| Rate for Payer: Cash Price |
$3,612.40
|
| 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 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 |
$4,755.85
|
| 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 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 |
$4,755.85
|
| Rate for Payer: Cash Price |
$4,755.85
|
| Rate for Payer: Cash Price |
$4,755.85
|
| Rate for Payer: Cash Price |
$4,755.85
|
| 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 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 |
$3,444.65
|
| 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 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 |
$3,444.65
|
| Rate for Payer: Cash Price |
$3,444.65
|
| Rate for Payer: Cash Price |
$3,444.65
|
| Rate for Payer: Cash Price |
$3,444.65
|
| 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 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 |
$5,414.75
|
| Rate for Payer: Cash Price |
$5,414.75
|
| Rate for Payer: Cash Price |
$5,414.75
|
| Rate for Payer: Cash Price |
$5,414.75
|
| 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
|
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 |
$5,414.75
|
| 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
|
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 |
$5,414.75
|
| Rate for Payer: Cash Price |
$5,414.75
|
| Rate for Payer: Cash Price |
$5,414.75
|
| Rate for Payer: Cash Price |
$5,414.75
|
| 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 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 |
$5,414.75
|
| 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 VULVA OR PERI ABSC
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,431.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Cash Price |
$874.50
|
| 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
|
|
|
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 |
$874.50
|
| 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
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$651.90
|
| 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 |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,272.00
|
| Rate for Payer: Cigna of CA HMO |
$1,017.60
|
| Rate for Payer: Cigna of CA PPO |
$1,176.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| 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: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,060.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$1,033.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,351.50
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$954.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$954.00
|
| 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 |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| 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 |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| 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 |
$615.83
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,272.00
|
| Rate for Payer: Cigna of CA HMO |
$1,017.60
|
| Rate for Payer: Cigna of CA PPO |
$1,176.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| 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: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,060.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$1,033.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,351.50
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$954.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.00
|
| Rate for Payer: United Healthcare All Other HMO |
$795.00
|
| Rate for Payer: United Healthcare HMO Rider |
$795.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$795.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| 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 |
$615.83
|
| 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 |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,272.00
|
| Rate for Payer: Cigna of CA HMO |
$1,017.60
|
| Rate for Payer: Cigna of CA PPO |
$1,176.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| 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: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$156.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,060.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$1,033.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,351.50
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$954.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,431.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Cash Price |
$874.50
|
| 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
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Blue Shield of California Commercial |
$117.50
|
| Rate for Payer: Blue Shield of California EPN |
$76.61
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.27
|
| Rate for Payer: Blue Shield of California Commercial |
$92.87
|
| Rate for Payer: Blue Shield of California EPN |
$60.65
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: InnovAge PACE Commercial |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
