|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$1,044.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$939.60 |
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Central Health Plan Commercial |
$835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.60
|
| Rate for Payer: Galaxy Health WC |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$939.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$1,044.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$626.40
|
| Rate for Payer: Blue Shield of California Commercial |
$656.68
|
| Rate for Payer: Blue Shield of California EPN |
$510.52
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Central Health Plan Commercial |
$835.20
|
| Rate for Payer: Cigna of CA HMO |
$668.16
|
| Rate for Payer: Cigna of CA PPO |
$772.56
|
| 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 |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$939.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$783.00
|
| 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 |
$696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
| 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 |
$626.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$626.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$522.00
|
| Rate for Payer: United Healthcare All Other HMO |
$522.00
|
| Rate for Payer: United Healthcare HMO Rider |
$522.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$522.00
|
| 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 I & D EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$1,044.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$939.60 |
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Central Health Plan Commercial |
$835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.60
|
| Rate for Payer: Galaxy Health WC |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$939.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$1,044.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$626.40
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Central Health Plan Commercial |
$835.20
|
| Rate for Payer: Cigna of CA PPO |
$772.56
|
| 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 |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$939.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$783.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
| 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 |
$626.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$522.00
|
| Rate for Payer: United Healthcare All Other HMO |
$522.00
|
| Rate for Payer: United Healthcare HMO Rider |
$522.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$522.00
|
| 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 I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,098.20 |
| Max. Negotiated Rate |
$4,941.90 |
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,196.40
|
| Rate for Payer: Galaxy Health WC |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,092.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$4,941.90 |
| 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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,294.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,453.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,685.10
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: Cigna of CA HMO |
$3,514.24
|
| Rate for Payer: Cigna of CA PPO |
$4,063.34
|
| 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 |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,118.25
|
| 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 |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
| 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 |
$3,294.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,294.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,745.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,745.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,745.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,745.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,294.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: Cigna of CA PPO |
$4,063.34
|
| 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 |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,118.25
|
| 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 |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
| 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 |
$3,294.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,098.20 |
| Max. Negotiated Rate |
$4,941.90 |
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,196.40
|
| Rate for Payer: Galaxy Health WC |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,092.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,098.20 |
| Max. Negotiated Rate |
$4,941.90 |
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,196.40
|
| Rate for Payer: Galaxy Health WC |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,092.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$1,098.20 |
| Max. Negotiated Rate |
$4,941.90 |
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,196.40
|
| Rate for Payer: Galaxy Health WC |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,092.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$4,941.90 |
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,294.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,453.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,685.10
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: Cigna of CA HMO |
$3,514.24
|
| Rate for Payer: Cigna of CA PPO |
$4,063.34
|
| 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 |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,118.25
|
| 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 |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
| 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 |
$3,294.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,294.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$4,941.90 |
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,294.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,453.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,685.10
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: Cigna of CA HMO |
$3,514.24
|
| Rate for Payer: Cigna of CA PPO |
$4,063.34
|
| 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 |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,118.25
|
| 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 |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
| 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 |
$3,294.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,294.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,745.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,745.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,745.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,745.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,098.20 |
| Max. Negotiated Rate |
$4,941.90 |
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,196.40
|
| Rate for Payer: Galaxy Health WC |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,092.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$5,491.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$4,941.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| 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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,294.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Cash Price |
$2,470.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,392.80
|
| Rate for Payer: Cigna of CA PPO |
$4,063.34
|
| 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 |
$4,667.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,941.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,118.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,662.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,118.25
|
| Rate for Payer: Networks By Design Commercial |
$3,569.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,667.35
|
| 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 |
$3,294.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,745.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,745.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,745.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,745.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC I & D LACRIMAL SAC
|
Facility
|
OP
|
$6,984.00
|
|
|
Service Code
|
CPT 68420
|
| Hospital Charge Code |
902890372
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$379.87 |
| Max. Negotiated Rate |
$6,285.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,190.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,392.94
|
| Rate for Payer: Blue Shield of California EPN |
$3,415.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,587.20
|
| Rate for Payer: Cigna of CA HMO |
$4,469.76
|
| Rate for Payer: Cigna of CA PPO |
$5,168.16
|
| 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 |
$5,936.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,190.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,285.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,238.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,817.46
|
| 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 |
$4,658.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,396.80
|
| 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 |
$5,238.00
|
| Rate for Payer: Networks By Design Commercial |
$4,539.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,936.40
|
| 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 |
$4,190.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,190.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,492.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,492.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,492.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,492.00
|
| 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 I & D LACRIMAL SAC
|
Facility
|
IP
|
$6,984.00
|
|
|
Service Code
|
CPT 68420
|
| Hospital Charge Code |
902890372
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,396.80 |
| Max. Negotiated Rate |
$6,285.60 |
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,587.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,793.60
|
| Rate for Payer: Galaxy Health WC |
$5,936.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,190.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,285.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,658.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,660.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,396.80
|
| Rate for Payer: Multiplan Commercial |
$5,238.00
|
| Rate for Payer: Networks By Design Commercial |
$4,539.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,936.40
|
|
|
HC I&D OF MTH LSN;MSTCTR SPACE
|
Facility
|
IP
|
$4,736.00
|
|
|
Service Code
|
CPT 41018
|
| Hospital Charge Code |
900541018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$947.20 |
| Max. Negotiated Rate |
$4,262.40 |
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,894.40
|
| Rate for Payer: Galaxy Health WC |
$4,025.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,841.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,262.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,158.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,804.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.20
|
| Rate for Payer: Multiplan Commercial |
$3,552.00
|
| Rate for Payer: Networks By Design Commercial |
$3,078.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,025.60
|
|
|
HC I&D OF MTH LSN;MSTCTR SPACE
|
Facility
|
OP
|
$4,736.00
|
|
|
Service Code
|
CPT 41018
|
| Hospital Charge Code |
900541018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$4,262.40 |
| 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 |
$2,841.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,788.80
|
| Rate for Payer: Cigna of CA PPO |
$3,504.64
|
| 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 |
$4,025.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,841.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,262.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,552.00
|
| 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 |
$3,158.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.20
|
| 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 |
$3,552.00
|
| Rate for Payer: Networks By Design Commercial |
$3,078.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,025.60
|
| 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 |
$2,841.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,368.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,368.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,368.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,368.00
|
| 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 I & D OF SCROTUM
|
Facility
|
IP
|
$9,012.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,802.40 |
| Max. Negotiated Rate |
$8,110.80 |
| Rate for Payer: Cash Price |
$4,055.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,209.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,604.80
|
| Rate for Payer: Galaxy Health WC |
$7,660.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,407.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,011.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,433.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.40
|
| Rate for Payer: Multiplan Commercial |
$6,759.00
|
| Rate for Payer: Networks By Design Commercial |
$5,857.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,660.20
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$9,012.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$377.04 |
| Max. Negotiated Rate |
$8,110.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| 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 |
$5,407.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$4,055.40
|
| Rate for Payer: Cash Price |
$4,055.40
|
| Rate for Payer: Cash Price |
$4,055.40
|
| Rate for Payer: Cash Price |
$4,055.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,209.60
|
| Rate for Payer: Cigna of CA PPO |
$6,668.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$7,660.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,407.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,110.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,759.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,011.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$6,759.00
|
| Rate for Payer: Networks By Design Commercial |
$5,857.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,660.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,407.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,506.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$9,012.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$377.04 |
| Max. Negotiated Rate |
$8,110.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| 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 |
$5,407.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,668.55
|
| Rate for Payer: Blue Shield of California EPN |
$4,406.87
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$4,055.40
|
| Rate for Payer: Cash Price |
$4,055.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,209.60
|
| Rate for Payer: Cigna of CA HMO |
$5,767.68
|
| Rate for Payer: Cigna of CA PPO |
$6,668.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$7,660.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,407.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,110.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,759.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,011.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$6,759.00
|
| Rate for Payer: Networks By Design Commercial |
$5,857.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,660.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,407.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,407.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,506.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC I & D OF SCROTUM
|
Facility
|
IP
|
$9,012.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,802.40 |
| Max. Negotiated Rate |
$8,110.80 |
| Rate for Payer: Cash Price |
$4,055.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,209.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,604.80
|
| Rate for Payer: Galaxy Health WC |
$7,660.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,407.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,011.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,433.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.40
|
| Rate for Payer: Multiplan Commercial |
$6,759.00
|
| Rate for Payer: Networks By Design Commercial |
$5,857.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,660.20
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| 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 |
$873.60
|
| Rate for Payer: Caremore Medicare Advantage |
$400.82
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.80
|
| Rate for Payer: Cigna of CA PPO |
$1,077.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$1,237.60
|
| Rate for Payer: Global Benefits Group Commercial |
$873.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,310.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,092.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: InnovAge PACE Commercial |
$601.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$971.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: Networks By Design Commercial |
$946.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Medicare |
$424.87
|
| Rate for Payer: Riverside University Health System MISP |
$440.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$728.00
|
| Rate for Payer: United Healthcare All Other HMO |
$728.00
|
| Rate for Payer: United Healthcare HMO Rider |
$728.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$1,310.40 |
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.40
|
| Rate for Payer: Galaxy Health WC |
$1,237.60
|
| Rate for Payer: Global Benefits Group Commercial |
$873.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,310.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$971.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.20
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: Networks By Design Commercial |
$946.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,237.60
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$1,310.40 |
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.40
|
| Rate for Payer: Galaxy Health WC |
$1,237.60
|
| Rate for Payer: Global Benefits Group Commercial |
$873.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,310.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$971.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.20
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: Networks By Design Commercial |
$946.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,237.60
|
|
