|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 100 SQCM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT C5278
|
| Hospital Charge Code |
900101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$664.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.96
|
| Rate for Payer: Blue Shield of California Commercial |
$694.23
|
| Rate for Payer: Blue Shield of California EPN |
$436.90
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 100 SQCM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT C5278
|
| Hospital Charge Code |
900101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 25 SQCM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT C5276
|
| Hospital Charge Code |
900101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 25 SQCM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT C5276
|
| Hospital Charge Code |
900101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$664.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.96
|
| Rate for Payer: Blue Shield of California Commercial |
$694.23
|
| Rate for Payer: Blue Shield of California EPN |
$436.90
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 100 SQCM
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
CPT C5273
|
| Hospital Charge Code |
900101511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.00 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,862.00
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,221.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 100 SQCM
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
CPT C5273
|
| Hospital Charge Code |
900101511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.00 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,345.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,081.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,935.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,366.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,464.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,162.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,536.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,854.84
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: Cigna of CA HMO |
$4,579.20
|
| Rate for Payer: Cigna of CA PPO |
$5,294.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,081.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,081.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,081.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,862.00
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,597.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,221.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,008.50
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,862.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,293.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,293.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,577.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,081.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,081.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,081.75
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 25 SQCM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
900101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.66 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,863.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,205.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,644.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,275.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,389.73
|
| Rate for Payer: Blue Shield of California EPN |
$874.61
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Cigna of CA HMO |
$1,402.88
|
| Rate for Payer: Cigna of CA PPO |
$1,622.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,863.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,863.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,863.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,391.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$795.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,293.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,534.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
| Rate for Payer: Riverside University Health System MISP |
$876.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,863.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,863.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,863.20
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 25 SQCM
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
900101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,391.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,293.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 100 SQCM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT C5274
|
| Hospital Charge Code |
900101512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.60 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,504.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,111.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 100 SQCM
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT C5274
|
| Hospital Charge Code |
900101512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.60 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,172.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,683.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,732.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,081.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Cigna of CA HMO |
$2,289.92
|
| Rate for Payer: Cigna of CA PPO |
$2,647.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,041.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,041.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,504.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,298.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,111.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,504.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,431.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,789.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,041.30
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 25 SQCM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
900101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.96
|
| Rate for Payer: Blue Shield of California Commercial |
$694.23
|
| Rate for Payer: Blue Shield of California EPN |
$436.90
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 25 SQCM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
900101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC LOWER EXT ARTERIAL EXAM, BILAT
|
Facility
|
IP
|
$1,724.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
908100113
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$1,551.60 |
| Rate for Payer: Adventist Health Commercial |
$344.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,379.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,206.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.60
|
| Rate for Payer: EPIC Health Plan Senior |
$689.60
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,551.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,094.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,017.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.80
|
| Rate for Payer: Multiplan Commercial |
$1,293.00
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
|
|
HC LOWER EXT ARTERIAL EXAM, BILAT
|
Facility
|
OP
|
$1,724.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
908100113
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$183.04 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$344.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,224.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$642.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,002.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.12
|
| Rate for Payer: Blue Shield of California EPN |
$684.43
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,379.20
|
| Rate for Payer: Cigna of CA HMO |
$1,103.36
|
| Rate for Payer: Cigna of CA PPO |
$1,275.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,206.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,551.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,094.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,293.00
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,034.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,034.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC LOWER XTR FASCIAL PLANE BLOCK UNI INJECTION
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
950964473
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,076.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,468.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,566.40
|
| Rate for Payer: Cigna of CA HMO |
$1,253.12
|
| Rate for Payer: Cigna of CA PPO |
$1,448.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,664.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,664.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,370.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,762.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,243.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,155.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,370.60
|
| Rate for Payer: Multiplan Commercial |
$1,468.50
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Riverside University Health System MISP |
$783.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.00
|
| Rate for Payer: United Healthcare All Other HMO |
$979.00
|
| Rate for Payer: United Healthcare HMO Rider |
$979.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$979.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,664.30
|
|
|
HC LOWER XTR FASCIAL PLANE BLOCK UNI INJECTION
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
950964473
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$1,762.20 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,566.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,370.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,762.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,243.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,155.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.60
|
| Rate for Payer: Multiplan Commercial |
$1,468.50
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$484.20 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Central Health Plan Commercial |
$430.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Senior |
$215.20
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$341.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$317.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.60
|
| Rate for Payer: Multiplan Commercial |
$403.50
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$260.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.95
|
| Rate for Payer: Blue Shield of California Commercial |
$341.09
|
| Rate for Payer: Blue Shield of California EPN |
$214.66
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Central Health Plan Commercial |
$430.40
|
| Rate for Payer: Cigna of CA HMO |
$344.32
|
| Rate for Payer: Cigna of CA PPO |
$398.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$341.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$403.50
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$623.23 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$623.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$623.23
|
| Rate for Payer: Blue Shield of California Commercial |
$393.12
|
| Rate for Payer: Blue Shield of California Commercial |
$326.34
|
| Rate for Payer: Blue Shield of California EPN |
$247.73
|
| Rate for Payer: Blue Shield of California EPN |
$205.65
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Central Health Plan Commercial |
$414.40
|
| Rate for Payer: Central Health Plan Commercial |
$499.20
|
| Rate for Payer: Cigna of CA HMO |
$399.36
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$461.76
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$561.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$466.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$396.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$374.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$374.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Central Health Plan Commercial |
$499.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: EPIC Health Plan Senior |
$249.60
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$561.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$396.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$368.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
|
|
HC LRNGSCPY, FLXBL W BX OR BXS
|
Facility
|
OP
|
$5,904.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
900500576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,180.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,723.20
|
| Rate for Payer: Cigna of CA HMO |
$3,778.56
|
| Rate for Payer: Cigna of CA PPO |
$4,368.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Galaxy Health WC |
$5,018.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,313.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,749.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,460.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,180.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$3,837.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,018.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,426.61
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,518.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,952.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC LRNGSCPY, FLXBL W BX OR BXS
|
Facility
|
IP
|
$5,904.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
900500576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,180.80 |
| Max. Negotiated Rate |
$5,313.60 |
| Rate for Payer: Adventist Health Commercial |
$1,180.80
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,723.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,361.60
|
| Rate for Payer: Galaxy Health WC |
$5,018.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,313.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,749.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,483.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,180.80
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Networks By Design Commercial |
$3,837.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,018.40
|
|
|
HC LSO CORSET FRONT
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
905350972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Blue Shield of California Commercial |
$327.22
|
| Rate for Payer: Blue Shield of California EPN |
$205.63
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
|
|
HC LSO CORSET FRONT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
905350972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$167.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.33
|
| Rate for Payer: Blue Shield of California Commercial |
$327.22
|
| Rate for Payer: Blue Shield of California EPN |
$205.63
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Riverside University Health System MISP |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC LSO CORSET FRONT
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT L0972
|
| Hospital Charge Code |
915350972
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$167.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.33
|
| Rate for Payer: Blue Shield of California Commercial |
$327.22
|
| Rate for Payer: Blue Shield of California EPN |
$205.63
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Riverside University Health System MISP |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
