|
HC EXC BEN LES-HD/HND/FT 3.1-4.CM
|
Facility
|
IP
|
$6,653.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
900501737
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,330.60 |
| Max. Negotiated Rate |
$5,987.70 |
| Rate for Payer: Cash Price |
$2,993.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,322.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,661.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$4,437.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,534.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,330.60
|
| 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
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
IP
|
$2,662.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.40 |
| Max. Negotiated Rate |
$2,395.80 |
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,395.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.40
|
| Rate for Payer: Multiplan Commercial |
$1,996.50
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
OP
|
$2,662.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.45 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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 |
$1,597.20
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,129.60
|
| Rate for Payer: Cigna of CA PPO |
$1,969.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,395.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,996.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,996.50
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,597.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,331.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,331.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,331.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
OP
|
$2,662.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.45 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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 |
$1,597.20
|
| 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 |
$498.20
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,129.60
|
| Rate for Payer: Cigna of CA PPO |
$1,969.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,395.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,996.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,996.50
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,597.20
|
| 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 |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
IP
|
$2,662.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$532.40 |
| Max. Negotiated Rate |
$2,395.80 |
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,395.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.40
|
| Rate for Payer: Multiplan Commercial |
$1,996.50
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.35 |
| 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 |
$1,452.00
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: Cigna of CA PPO |
$1,790.80
|
| 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 |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,815.00
|
| 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 |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| 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 |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
| 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 |
$1,452.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,210.00
|
| 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 EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.35 |
| 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 |
$1,452.00
|
| 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 |
$879.07
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: Cigna of CA PPO |
$1,790.80
|
| 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 |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,815.00
|
| 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 |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| 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 |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
| 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 |
$1,452.00
|
| 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 EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$110.35 |
| 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 |
$1,452.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,183.38
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: Cigna of CA HMO |
$1,548.80
|
| Rate for Payer: Cigna of CA PPO |
$1,790.80
|
| 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 |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,815.00
|
| 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 |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| 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 |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
| 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 |
$1,452.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,452.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,210.00
|
| 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 EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.00
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| Rate for Payer: Multiplan Commercial |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.00
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| Rate for Payer: Multiplan Commercial |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
905501287
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$110.35 |
| 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 |
$1,452.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,183.38
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: Cigna of CA HMO |
$1,548.80
|
| Rate for Payer: Cigna of CA PPO |
$1,790.80
|
| 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 |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,815.00
|
| 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 |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| 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 |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
| 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 |
$1,452.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,452.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,210.00
|
| 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 EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
905501287
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.00
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| Rate for Payer: Multiplan Commercial |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.00
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| Rate for Payer: Multiplan Commercial |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
OP
|
$2,662.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$307.57 |
| 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 |
$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 |
$1,597.20
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,129.60
|
| Rate for Payer: Cigna of CA PPO |
$1,969.88
|
| 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 |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,395.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,996.50
|
| 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 |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.40
|
| 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 |
$1,996.50
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
| 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 |
$1,597.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,331.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,331.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,331.00
|
| 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 EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
IP
|
$2,662.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$532.40 |
| Max. Negotiated Rate |
$2,395.80 |
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,395.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.40
|
| Rate for Payer: Multiplan Commercial |
$1,996.50
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
OP
|
$2,662.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$307.57 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$1,597.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,674.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,301.72
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,129.60
|
| Rate for Payer: Cigna of CA HMO |
$1,703.68
|
| Rate for Payer: Cigna of CA PPO |
$1,969.88
|
| 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 |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,395.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,996.50
|
| 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 |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.40
|
| 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 |
$1,996.50
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
| 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 |
$1,597.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,597.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,331.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,331.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,331.00
|
| 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 EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
IP
|
$2,662.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$532.40 |
| Max. Negotiated Rate |
$2,395.80 |
| Rate for Payer: Cash Price |
$1,197.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.80
|
| Rate for Payer: Galaxy Health WC |
$2,262.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,395.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.40
|
| Rate for Payer: Multiplan Commercial |
$1,996.50
|
| Rate for Payer: Networks By Design Commercial |
$1,730.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,262.70
|
|
|
HC EXC FACIAL LESION 1.1-2.0 CM
|
Facility
|
OP
|
$3,509.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.08 |
| 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 |
$2,105.40
|
| 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 |
$1,579.05
|
| Rate for Payer: Cash Price |
$1,579.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,807.20
|
| Rate for Payer: Cigna of CA PPO |
$2,596.66
|
| 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 |
$2,982.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,105.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,158.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,631.75
|
| 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 |
$2,340.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.80
|
| 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 |
$2,631.75
|
| Rate for Payer: Networks By Design Commercial |
$2,280.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,982.65
|
| 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 |
$2,105.40
|
| 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 EXC FACIAL LESION 1.1-2.0 CM
|
Facility
|
OP
|
$3,509.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$152.08 |
| 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 |
$2,105.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,207.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,715.90
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,579.05
|
| Rate for Payer: Cash Price |
$1,579.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,807.20
|
| Rate for Payer: Cigna of CA HMO |
$2,245.76
|
| Rate for Payer: Cigna of CA PPO |
$2,596.66
|
| 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 |
$2,982.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,105.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,158.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,631.75
|
| 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 |
$2,340.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.80
|
| 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 |
$2,631.75
|
| Rate for Payer: Networks By Design Commercial |
$2,280.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,982.65
|
| 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 |
$2,105.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,105.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,754.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,754.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,754.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,754.50
|
| 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 EXC FACIAL LESION 1.1-2.0 CM
|
Facility
|
IP
|
$3,509.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$701.80 |
| Max. Negotiated Rate |
$3,158.10 |
| Rate for Payer: Cash Price |
$1,579.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,807.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,403.60
|
| Rate for Payer: Galaxy Health WC |
$2,982.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,105.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,158.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,340.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,336.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.80
|
| Rate for Payer: Multiplan Commercial |
$2,631.75
|
| Rate for Payer: Networks By Design Commercial |
$2,280.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,982.65
|
|
|
HC EXC FACIAL LESION 1.1-2.0 CM
|
Facility
|
IP
|
$3,509.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
902890020
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$701.80 |
| Max. Negotiated Rate |
$3,158.10 |
| Rate for Payer: Cash Price |
$1,579.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,807.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,403.60
|
| Rate for Payer: Galaxy Health WC |
$2,982.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,105.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,158.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,340.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,336.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.80
|
| Rate for Payer: Multiplan Commercial |
$2,631.75
|
| Rate for Payer: Networks By Design Commercial |
$2,280.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,982.65
|
|
|
HC EXC FACIAL LESION LT 0.5 CM
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
902890018
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.00
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| Rate for Payer: Multiplan Commercial |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
|
|
HC EXC FACIAL LESION LT 0.5 CM
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
902890018
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$1,452.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,183.38
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,936.00
|
| Rate for Payer: Cigna of CA HMO |
$1,548.80
|
| Rate for Payer: Cigna of CA PPO |
$1,790.80
|
| 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 |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,178.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,815.00
|
| 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 |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.00
|
| 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 |
$1,815.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
| 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 |
$1,452.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,452.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,210.00
|
| 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 EXCHANGE STEERABLE GW
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC EXCHANGE STEERABLE GW
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.24
|
| Rate for Payer: Blue Distinction Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$188.70
|
| Rate for Payer: Blue Shield of California EPN |
$146.70
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Media |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$225.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
