|
HC EXCHG BLD TRANS NEWBORN
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 36450
|
| Hospital Charge Code |
906812206
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$581.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
|
|
HC EXCHG BLD TRANS NEWBORN
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 36450
|
| Hospital Charge Code |
906812206
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| 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 |
$915.00
|
| Rate for Payer: Blue Shield of California Commercial |
$959.22
|
| Rate for Payer: Blue Shield of California EPN |
$745.72
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: Cigna of CA HMO |
$976.00
|
| Rate for Payer: Cigna of CA PPO |
$1,128.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,143.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: InnovAge PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Riverside University Health System MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$915.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$915.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC EXCHG BLD TRANS OTHER THAN NEWBORN
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
906812205
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$915.00
|
| Rate for Payer: Blue Shield of California Commercial |
$959.22
|
| Rate for Payer: Blue Shield of California EPN |
$745.72
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: Cigna of CA HMO |
$976.00
|
| Rate for Payer: Cigna of CA PPO |
$1,128.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,143.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: InnovAge PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Riverside University Health System MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$915.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$915.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC EXCHG BLD TRANS OTHER THAN NEWBORN
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
906812205
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$581.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
|
|
HC EXCISION ANAL LESION(S)
|
Facility
|
IP
|
$4,823.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
904000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$964.60 |
| Max. Negotiated Rate |
$4,340.70 |
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,858.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,929.20
|
| Rate for Payer: Galaxy Health WC |
$4,099.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,893.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,340.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,837.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.60
|
| Rate for Payer: Multiplan Commercial |
$3,617.25
|
| Rate for Payer: Networks By Design Commercial |
$3,134.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,099.55
|
|
|
HC EXCISION ANAL LESION(S)
|
Facility
|
OP
|
$4,823.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
904000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.09 |
| Max. Negotiated Rate |
$5,788.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,508.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| 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 |
$2,893.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,033.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,358.45
|
| Rate for Payer: Caremore Medicare Advantage |
$3,508.15
|
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,858.40
|
| Rate for Payer: Cigna of CA HMO |
$3,086.72
|
| Rate for Payer: Cigna of CA PPO |
$3,569.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Media |
$3,508.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,736.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,508.15
|
| Rate for Payer: Galaxy Health WC |
$4,099.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,893.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,340.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,617.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,753.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,788.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,508.15
|
| Rate for Payer: InnovAge PACE Commercial |
$5,262.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,508.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,700.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,700.92
|
| Rate for Payer: Multiplan Commercial |
$3,617.25
|
| Rate for Payer: Networks By Design Commercial |
$3,134.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,099.55
|
| Rate for Payer: Prime Health Services Medicare |
$3,718.64
|
| Rate for Payer: Riverside University Health System MISP |
$3,858.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,893.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,893.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,411.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,411.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,411.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC EXCISION OF CYST, FIBROADENOMA OR OTHER BENIGN OR MAGLIGNANT TUMOR
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
950442246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,004.40 |
| Max. Negotiated Rate |
$9,019.80 |
| Rate for Payer: Cash Price |
$4,509.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,017.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,008.80
|
| Rate for Payer: Galaxy Health WC |
$8,518.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,019.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,684.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,818.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.40
|
| Rate for Payer: Multiplan Commercial |
$7,516.50
|
| Rate for Payer: Networks By Design Commercial |
$6,514.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,518.70
|
|
|
HC EXCISION OF CYST, FIBROADENOMA OR OTHER BENIGN OR MAGLIGNANT TUMOR
|
Facility
|
OP
|
$10,022.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
950442246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.37 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,762.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,013.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,762.51
|
| Rate for Payer: Cash Price |
$4,509.90
|
| Rate for Payer: Cash Price |
$4,509.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,017.60
|
| Rate for Payer: Cigna of CA PPO |
$7,416.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$8,518.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,019.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,516.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,858.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: InnovAge PACE Commercial |
$7,143.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,684.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,381.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$7,516.50
|
| Rate for Payer: Networks By Design Commercial |
$6,514.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,518.70
|
| Rate for Payer: Prime Health Services Medicare |
$5,048.26
|
| Rate for Payer: Riverside University Health System MISP |
$5,238.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,013.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$7,675.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,535.00 |
| Max. Negotiated Rate |
$6,907.50 |
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,070.00
|
| Rate for Payer: Galaxy Health WC |
$6,523.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,907.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,924.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,535.00
|
| Rate for Payer: Multiplan Commercial |
$5,756.25
|
| Rate for Payer: Networks By Design Commercial |
$4,988.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,523.75
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$7,675.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,535.00 |
| Max. Negotiated Rate |
$6,907.50 |
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,070.00
|
| Rate for Payer: Galaxy Health WC |
$6,523.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,907.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,924.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,535.00
|
| Rate for Payer: Multiplan Commercial |
$5,756.25
|
| Rate for Payer: Networks By Design Commercial |
$4,988.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,523.75
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
OP
|
$7,675.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$6,907.50 |
| 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 |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,605.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,140.00
|
| Rate for Payer: Cigna of CA PPO |
$5,679.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,523.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,907.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,756.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,535.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,756.25
|
| Rate for Payer: Networks By Design Commercial |
$4,988.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,523.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,605.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,837.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,837.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,837.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
OP
|
$7,675.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$6,907.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,605.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,827.58
|
| Rate for Payer: Blue Shield of California EPN |
$3,753.08
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Cash Price |
$3,453.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,140.00
|
| Rate for Payer: Cigna of CA HMO |
$4,912.00
|
| Rate for Payer: Cigna of CA PPO |
$5,679.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,523.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,907.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,756.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,637.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,535.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,756.25
|
| Rate for Payer: Networks By Design Commercial |
$4,988.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,523.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,605.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,605.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,837.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,837.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,837.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
IP
|
$2,767.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$553.40 |
| Max. Negotiated Rate |
$2,490.30 |
| Rate for Payer: Cash Price |
$1,245.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,106.80
|
| Rate for Payer: Galaxy Health WC |
$2,351.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,660.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,490.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,845.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,054.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$553.40
|
| Rate for Payer: Multiplan Commercial |
$2,075.25
|
| Rate for Payer: Networks By Design Commercial |
$1,798.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,351.95
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
OP
|
$2,767.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$3,124.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,660.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$1,245.15
|
| Rate for Payer: Cash Price |
$1,245.15
|
| Rate for Payer: Cash Price |
$1,245.15
|
| Rate for Payer: Cash Price |
$1,245.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,213.60
|
| Rate for Payer: Cigna of CA PPO |
$2,047.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$2,351.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,660.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,490.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,075.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: InnovAge PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,845.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,054.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$553.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$2,075.25
|
| Rate for Payer: Networks By Design Commercial |
$1,798.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,351.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health System MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,660.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,383.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,383.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,383.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,383.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
IP
|
$7,979.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,595.80 |
| Max. Negotiated Rate |
$7,181.10 |
| Rate for Payer: Cash Price |
$3,590.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,383.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,191.60
|
| Rate for Payer: Galaxy Health WC |
$6,782.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,787.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,181.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,321.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,040.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,595.80
|
| Rate for Payer: Multiplan Commercial |
$5,984.25
|
| Rate for Payer: Networks By Design Commercial |
$5,186.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,782.15
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
OP
|
$7,979.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,787.40
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$3,590.55
|
| Rate for Payer: Cash Price |
$3,590.55
|
| Rate for Payer: Cash Price |
$3,590.55
|
| Rate for Payer: Cash Price |
$3,590.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,383.20
|
| Rate for Payer: Cigna of CA PPO |
$5,904.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$6,782.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,787.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,181.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,984.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,321.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$877.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,595.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$5,984.25
|
| Rate for Payer: Networks By Design Commercial |
$5,186.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,782.15
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,787.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,989.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,989.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,989.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,989.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$6,933.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,622.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,845.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,767.26
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: Cigna of CA HMO |
$4,930.56
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,778.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,637.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
IP
|
$7,704.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,540.80 |
| Max. Negotiated Rate |
$6,933.60 |
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
IP
|
$7,704.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,540.80 |
| Max. Negotiated Rate |
$6,933.60 |
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$6,933.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,622.40
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,778.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXCISION VAGINAL SEPTUM
|
Facility
|
OP
|
$8,745.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
900500130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.07 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| 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 |
$5,247.00
|
| 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 |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,996.00
|
| Rate for Payer: Cigna of CA PPO |
$6,471.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$7,433.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,247.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,870.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,558.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,749.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,558.75
|
| Rate for Payer: Networks By Design Commercial |
$5,684.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,433.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,247.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC EXCISION VAGINAL SEPTUM
|
Facility
|
IP
|
$8,745.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
900500130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,749.00 |
| Max. Negotiated Rate |
$7,870.50 |
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,996.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,498.00
|
| Rate for Payer: Galaxy Health WC |
$7,433.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,247.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,870.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,331.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,749.00
|
| Rate for Payer: Multiplan Commercial |
$6,558.75
|
| Rate for Payer: Networks By Design Commercial |
$5,684.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,433.25
|
|
|
HC EXC SKIN LESION 0.6-1.0 CM
|
Facility
|
IP
|
$4,636.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
902890016
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$927.20 |
| Max. Negotiated Rate |
$4,172.40 |
| Rate for Payer: Cash Price |
$2,086.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,708.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,854.40
|
| Rate for Payer: Galaxy Health WC |
$3,940.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,781.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,172.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,092.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,766.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$927.20
|
| Rate for Payer: Multiplan Commercial |
$3,477.00
|
| Rate for Payer: Networks By Design Commercial |
$3,013.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,940.60
|
|
|
HC EXC SKIN LESION 0.6-1.0 CM
|
Facility
|
OP
|
$4,636.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
902890016
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$127.32 |
| 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 |
$2,781.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,916.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,267.00
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$2,086.20
|
| Rate for Payer: Cash Price |
$2,086.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,708.80
|
| Rate for Payer: Cigna of CA HMO |
$2,967.04
|
| Rate for Payer: Cigna of CA PPO |
$3,430.64
|
| 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 |
$3,940.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,781.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,172.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,477.00
|
| 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 |
$3,092.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$927.20
|
| 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 |
$3,477.00
|
| Rate for Payer: Networks By Design Commercial |
$3,013.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,940.60
|
| 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 |
$2,781.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,781.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,318.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,318.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,318.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,318.00
|
| 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 SKIN LESION 1.1-2.0 CM
|
Facility
|
OP
|
$5,099.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
902890017
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$5,779.00 |
| 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 |
$3,059.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,207.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,493.41
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,294.55
|
| Rate for Payer: Cash Price |
$2,294.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,079.20
|
| Rate for Payer: Cigna of CA HMO |
$3,263.36
|
| Rate for Payer: Cigna of CA PPO |
$3,773.26
|
| 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 |
$4,334.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,059.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,589.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,824.25
|
| 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 |
$3,401.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.80
|
| 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 |
$3,824.25
|
| Rate for Payer: Networks By Design Commercial |
$3,314.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,334.15
|
| 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 |
$3,059.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,059.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,549.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,549.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,549.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,549.50
|
| 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
|
|
