|
HC EWHO W/JOINT(S) CF
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$733.25 |
| Max. Negotiated Rate |
$1,885.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,152.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,014.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,237.73
|
| Rate for Payer: Blue Distinction Transplant |
$1,257.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,571.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,139.68
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.00
|
| Rate for Payer: Cigna of CA HMO |
$1,466.50
|
| Rate for Payer: Cigna of CA PPO |
$1,466.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Dignity Health Media |
$1,780.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,780.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,885.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,571.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$733.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,397.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.95
|
| Rate for Payer: Multiplan Commercial |
$1,571.25
|
| Rate for Payer: Networks By Design Commercial |
$1,047.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: Riverside University Health System MISP |
$838.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,257.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,047.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,047.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,047.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,047.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.75
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$1,885.50 |
| Rate for Payer: Blue Shield of California EPN |
$1,118.73
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.00
|
| Rate for Payer: Cigna of CA HMO |
$1,466.50
|
| Rate for Payer: Cigna of CA PPO |
$1,466.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,885.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,397.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.00
|
| Rate for Payer: Multiplan Commercial |
$1,571.25
|
| Rate for Payer: Networks By Design Commercial |
$1,047.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$791.07
|
| Rate for Payer: United Healthcare All Other HMO |
$772.64
|
| Rate for Payer: United Healthcare HMO Rider |
$755.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$691.35
|
|
|
HC EXAMINATION OF VAGINA
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
904000018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Central Health Plan Commercial |
$436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.40
|
| Rate for Payer: Galaxy Health WC |
$464.10
|
| Rate for Payer: Global Benefits Group Commercial |
$327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$491.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$364.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$409.50
|
| Rate for Payer: Networks By Design Commercial |
$354.90
|
| Rate for Payer: Prime Health Services Commercial |
$464.10
|
|
|
HC EXAMINATION OF VAGINA
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
904000018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$248.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$327.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$248.97
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Central Health Plan Commercial |
$436.80
|
| Rate for Payer: Cigna of CA PPO |
$404.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$464.10
|
| Rate for Payer: Global Benefits Group Commercial |
$327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$491.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$409.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$408.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$410.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: InnovAge PACE Commercial |
$373.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$364.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$409.50
|
| Rate for Payer: Networks By Design Commercial |
$354.90
|
| Rate for Payer: Prime Health Services Commercial |
$464.10
|
| Rate for Payer: Prime Health Services Medicare |
$263.91
|
| Rate for Payer: Riverside University Health System MISP |
$273.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$3,183.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$136.52 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,909.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,002.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.49
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,546.40
|
| Rate for Payer: Cigna of CA HMO |
$2,037.12
|
| Rate for Payer: Cigna of CA PPO |
$2,355.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,705.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,909.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,864.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,387.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Networks By Design Commercial |
$2,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,705.55
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,909.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,909.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,591.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,591.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,591.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,591.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
IP
|
$3,183.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.60 |
| Max. Negotiated Rate |
$2,864.70 |
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,546.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,273.20
|
| Rate for Payer: Galaxy Health WC |
$2,705.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,909.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,864.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,212.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.60
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Networks By Design Commercial |
$2,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,705.55
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
IP
|
$3,183.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$636.60 |
| Max. Negotiated Rate |
$2,864.70 |
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,546.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,273.20
|
| Rate for Payer: Galaxy Health WC |
$2,705.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,909.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,864.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,212.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.60
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Networks By Design Commercial |
$2,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,705.55
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
IP
|
$3,183.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$636.60 |
| Max. Negotiated Rate |
$2,864.70 |
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,546.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,273.20
|
| Rate for Payer: Galaxy Health WC |
$2,705.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,909.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,864.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,212.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.60
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Networks By Design Commercial |
$2,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,705.55
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$3,183.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.52 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,909.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,546.40
|
| Rate for Payer: Cigna of CA PPO |
$2,355.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,705.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,909.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,864.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,387.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Networks By Design Commercial |
$2,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,705.55
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,909.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$3,183.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.52 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,909.80
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,546.40
|
| Rate for Payer: Cigna of CA PPO |
$2,355.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,705.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,909.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,864.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,387.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Networks By Design Commercial |
$2,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,705.55
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,909.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,591.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,591.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,591.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,591.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$347.47 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,425.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,234.40
|
| Rate for Payer: Cigna of CA PPO |
$2,991.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,638.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,032.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.47 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,425.80
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,234.40
|
| Rate for Payer: Cigna of CA PPO |
$2,991.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,638.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,032.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,021.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,021.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,021.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$3,638.70 |
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,234.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,638.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.60
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$3,638.70 |
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,234.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,638.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.60
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
|
|
HC EX BENIGN LES 3.1 - 4.0 CM
|
Facility
|
OP
|
$6,105.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
900501791
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,663.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,747.25
|
| Rate for Payer: Cash Price |
$2,747.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,884.00
|
| Rate for Payer: Cigna of CA PPO |
$4,517.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$5,189.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,494.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,578.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,072.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,578.75
|
| Rate for Payer: Networks By Design Commercial |
$3,968.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,189.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,663.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC EX BENIGN LES 3.1 - 4.0 CM
|
Facility
|
IP
|
$6,105.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
900501791
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$5,494.50 |
| Rate for Payer: Cash Price |
$2,747.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,442.00
|
| Rate for Payer: Galaxy Health WC |
$5,189.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,494.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,072.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,326.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.00
|
| Rate for Payer: Multiplan Commercial |
$4,578.75
|
| Rate for Payer: Networks By Design Commercial |
$3,968.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,189.25
|
|
|
HC EX BENIGN LES GT 4CM
|
Facility
|
IP
|
$7,909.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,581.80 |
| Max. Negotiated Rate |
$7,118.10 |
| Rate for Payer: Cash Price |
$3,559.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,327.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,163.60
|
| Rate for Payer: Galaxy Health WC |
$6,722.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,118.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,275.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,013.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.80
|
| Rate for Payer: Multiplan Commercial |
$5,931.75
|
| Rate for Payer: Networks By Design Commercial |
$5,140.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,722.65
|
|
|
HC EX BENIGN LES GT 4CM
|
Facility
|
OP
|
$7,909.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$550.72 |
| Max. Negotiated Rate |
$7,118.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,745.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,559.05
|
| Rate for Payer: Cash Price |
$3,559.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,327.20
|
| Rate for Payer: Cigna of CA PPO |
$5,852.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$6,722.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,118.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,931.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,275.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$5,931.75
|
| Rate for Payer: Networks By Design Commercial |
$5,140.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,722.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,745.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC EX BENIGN LES GT 4CM
|
Facility
|
IP
|
$7,909.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,581.80 |
| Max. Negotiated Rate |
$7,118.10 |
| Rate for Payer: Cash Price |
$3,559.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,327.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,163.60
|
| Rate for Payer: Galaxy Health WC |
$6,722.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,118.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,275.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,013.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.80
|
| Rate for Payer: Multiplan Commercial |
$5,931.75
|
| Rate for Payer: Networks By Design Commercial |
$5,140.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,722.65
|
|
|
HC EX BENIGN LES GT 4CM
|
Facility
|
OP
|
$7,909.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
902890353
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$550.72 |
| Max. Negotiated Rate |
$7,118.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,745.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,974.76
|
| Rate for Payer: Blue Shield of California EPN |
$3,867.50
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,559.05
|
| Rate for Payer: Cash Price |
$3,559.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,327.20
|
| Rate for Payer: Cigna of CA HMO |
$5,061.76
|
| Rate for Payer: Cigna of CA PPO |
$5,852.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$6,722.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,118.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,931.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,275.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$5,931.75
|
| Rate for Payer: Networks By Design Commercial |
$5,140.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,722.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,745.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,745.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,954.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,954.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,954.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,954.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
IP
|
$4,130.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$826.00 |
| Max. Negotiated Rate |
$3,717.00 |
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,652.00
|
| Rate for Payer: Galaxy Health WC |
$3,510.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,478.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,717.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,754.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.00
|
| Rate for Payer: Multiplan Commercial |
$3,097.50
|
| Rate for Payer: Networks By Design Commercial |
$2,684.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,510.50
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
IP
|
$4,130.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$826.00 |
| Max. Negotiated Rate |
$3,717.00 |
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,652.00
|
| Rate for Payer: Galaxy Health WC |
$3,510.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,478.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,717.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,754.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.00
|
| Rate for Payer: Multiplan Commercial |
$3,097.50
|
| Rate for Payer: Networks By Design Commercial |
$2,684.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,510.50
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
OP
|
$4,130.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,597.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,019.57
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,304.00
|
| Rate for Payer: Cigna of CA HMO |
$2,643.20
|
| Rate for Payer: Cigna of CA PPO |
$3,056.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,510.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,478.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,717.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,097.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,754.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,097.50
|
| Rate for Payer: Networks By Design Commercial |
$2,684.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,510.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,478.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,478.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,065.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,065.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,065.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,065.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
OP
|
$4,130.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$6,248.00 |
| 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 |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,478.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,304.00
|
| Rate for Payer: Cigna of CA PPO |
$3,056.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,510.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,478.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,717.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,097.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,754.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,097.50
|
| Rate for Payer: Networks By Design Commercial |
$2,684.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,510.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,478.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,065.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,065.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,065.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,065.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC EXC BEN LES-HD/HND/FT 3.1-4.CM
|
Facility
|
OP
|
$6,653.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
900501737
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$6,248.00 |
| 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 |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,991.80
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,993.85
|
| Rate for Payer: Cash Price |
$2,993.85
|
| Rate for Payer: Cash Price |
$2,993.85
|
| Rate for Payer: Cash Price |
$2,993.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,322.40
|
| Rate for Payer: Cigna of CA PPO |
$4,923.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$5,655.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,991.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,987.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,989.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,437.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,330.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,989.75
|
| Rate for Payer: Networks By Design Commercial |
$4,324.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,655.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,991.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,326.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,326.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,326.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,326.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
