|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.82
|
| 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: Blue Shield of California Commercial |
$915.82
|
| Rate for Payer: Blue Shield of California EPN |
$711.98
|
| 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: Central Health Plan Commercial |
$1,164.80
|
| Rate for Payer: Cigna of CA HMO |
$931.84
|
| 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 |
$661.35
|
| 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: TriValley Medical Group Commercial/Senior |
$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
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.82
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$873.60
|
| 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 |
$400.82
|
| 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 |
$661.35
|
| 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 |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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
|
516
|
| 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. PENTAGASTRIN CONCENTRATIO
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.80
|
| Rate for Payer: Blue Distinction Transplant |
$91.20
|
| Rate for Payer: Blue Shield of California Commercial |
$95.61
|
| Rate for Payer: Blue Shield of California EPN |
$74.33
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Media |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Shield of California Commercial |
$114.00
|
| Rate for Payer: Blue Shield of California EPN |
$81.17
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
OP
|
$2,831.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.37 |
| 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 |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,698.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,141.93
|
| Rate for Payer: Cash Price |
$1,273.95
|
| Rate for Payer: Cash Price |
$1,273.95
|
| Rate for Payer: Cash Price |
$1,273.95
|
| Rate for Payer: Cash Price |
$1,273.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,264.80
|
| Rate for Payer: Cigna of CA PPO |
$2,094.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$2,406.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,698.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,547.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,123.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,888.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$2,123.25
|
| Rate for Payer: Networks By Design Commercial |
$1,840.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,406.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,256.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,698.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,415.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,415.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,415.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,415.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
IP
|
$2,831.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$566.20 |
| Max. Negotiated Rate |
$2,547.90 |
| Rate for Payer: Cash Price |
$1,273.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,132.40
|
| Rate for Payer: Galaxy Health WC |
$2,406.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,698.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,547.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,888.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.20
|
| Rate for Payer: Multiplan Commercial |
$2,123.25
|
| Rate for Payer: Networks By Design Commercial |
$1,840.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,406.35
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
OP
|
$2,831.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$151.37 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,141.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,698.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,780.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,384.36
|
| Rate for Payer: Caremore Medicare Advantage |
$1,141.93
|
| Rate for Payer: Cash Price |
$1,273.95
|
| Rate for Payer: Cash Price |
$1,273.95
|
| Rate for Payer: Cash Price |
$1,273.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,264.80
|
| Rate for Payer: Cigna of CA HMO |
$1,811.84
|
| Rate for Payer: Cigna of CA PPO |
$2,094.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$2,406.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,698.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,547.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,123.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,884.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,888.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$2,123.25
|
| Rate for Payer: Networks By Design Commercial |
$1,840.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,406.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,256.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,698.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,698.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,415.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,415.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,415.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,415.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
IP
|
$2,831.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$566.20 |
| Max. Negotiated Rate |
$2,547.90 |
| Rate for Payer: Cash Price |
$1,273.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,132.40
|
| Rate for Payer: Galaxy Health WC |
$2,406.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,698.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,547.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,888.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.20
|
| Rate for Payer: Multiplan Commercial |
$2,123.25
|
| Rate for Payer: Networks By Design Commercial |
$1,840.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,406.35
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| 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 |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| 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 |
$705.00
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Central Health Plan Commercial |
$940.00
|
| Rate for Payer: Cigna of CA PPO |
$869.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$998.75
|
| Rate for Payer: Global Benefits Group Commercial |
$705.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,057.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$881.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: InnovAge PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
| Rate for Payer: Networks By Design Commercial |
$763.75
|
| Rate for Payer: Prime Health Services Commercial |
$998.75
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Riverside University Health System MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$705.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$587.50
|
| Rate for Payer: United Healthcare All Other HMO |
$587.50
|
| Rate for Payer: United Healthcare HMO Rider |
$587.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$587.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$235.00 |
| Max. Negotiated Rate |
$1,057.50 |
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Central Health Plan Commercial |
$940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.00
|
| Rate for Payer: Galaxy Health WC |
$998.75
|
| Rate for Payer: Global Benefits Group Commercial |
$705.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,057.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.00
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
| Rate for Payer: Networks By Design Commercial |
$763.75
|
| Rate for Payer: Prime Health Services Commercial |
$998.75
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$305.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| 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 |
$705.00
|
| Rate for Payer: Blue Shield of California Commercial |
$739.08
|
| Rate for Payer: Blue Shield of California EPN |
$574.58
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Central Health Plan Commercial |
$940.00
|
| Rate for Payer: Cigna of CA HMO |
$752.00
|
| Rate for Payer: Cigna of CA PPO |
$869.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$998.75
|
| Rate for Payer: Global Benefits Group Commercial |
$705.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,057.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$881.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: InnovAge PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
| Rate for Payer: Networks By Design Commercial |
$763.75
|
| Rate for Payer: Prime Health Services Commercial |
$998.75
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Riverside University Health System MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$705.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$705.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$587.50
|
| Rate for Payer: United Healthcare All Other HMO |
$587.50
|
| Rate for Payer: United Healthcare HMO Rider |
$587.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$587.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.00 |
| Max. Negotiated Rate |
$1,057.50 |
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Central Health Plan Commercial |
$940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.00
|
| Rate for Payer: Galaxy Health WC |
$998.75
|
| Rate for Payer: Global Benefits Group Commercial |
$705.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,057.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.00
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
| Rate for Payer: Networks By Design Commercial |
$763.75
|
| Rate for Payer: Prime Health Services Commercial |
$998.75
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
IP
|
$5,142.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,028.40 |
| Max. Negotiated Rate |
$4,627.80 |
| Rate for Payer: Cash Price |
$2,313.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.80
|
| Rate for Payer: Galaxy Health WC |
$4,370.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,085.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,627.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,959.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.40
|
| Rate for Payer: Multiplan Commercial |
$3,856.50
|
| Rate for Payer: Networks By Design Commercial |
$3,342.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,370.70
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
IP
|
$5,142.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,028.40 |
| Max. Negotiated Rate |
$4,627.80 |
| Rate for Payer: Cash Price |
$2,313.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.80
|
| Rate for Payer: Galaxy Health WC |
$4,370.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,085.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,627.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,959.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.40
|
| Rate for Payer: Multiplan Commercial |
$3,856.50
|
| Rate for Payer: Networks By Design Commercial |
$3,342.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,370.70
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
OP
|
$5,142.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$219.51 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,085.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,234.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,514.44
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$2,313.90
|
| Rate for Payer: Cash Price |
$2,313.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,113.60
|
| Rate for Payer: Cigna of CA HMO |
$3,290.88
|
| Rate for Payer: Cigna of CA PPO |
$3,805.08
|
| 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 |
$4,370.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,085.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,627.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,856.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$3,856.50
|
| Rate for Payer: Networks By Design Commercial |
$3,342.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,370.70
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,085.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,085.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,571.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,571.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,571.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,571.00
|
| 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 PILONIDAL CYST COMPLICAT
|
Facility
|
OP
|
$5,142.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.51 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,085.20
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$2,313.90
|
| Rate for Payer: Cash Price |
$2,313.90
|
| Rate for Payer: Cash Price |
$2,313.90
|
| Rate for Payer: Cash Price |
$2,313.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,113.60
|
| Rate for Payer: Cigna of CA PPO |
$3,805.08
|
| 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 |
$4,370.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,085.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,627.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,856.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$3,856.50
|
| Rate for Payer: Networks By Design Commercial |
$3,342.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,370.70
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,085.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,571.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,571.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,571.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,571.00
|
| 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 PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$986.40 |
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$986.40 |
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$219.20 |
| 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 |
$657.60
|
| Rate for Payer: Blue Shield of California Commercial |
$689.38
|
| Rate for Payer: Blue Shield of California EPN |
$535.94
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: Cigna of CA HMO |
$701.44
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| 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 |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$822.00
|
| 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 |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.00
|
| 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 PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.20 |
| 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 |
$657.60
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| 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 |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$822.00
|
| 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 |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.00
|
| 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 IDR CORDIS VISTA BRITE TIPN
|
Facility
|
OP
|
$5,293.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,499.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,911.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,175.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,234.40
|
| Rate for Payer: Cigna of CA PPO |
$3,916.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,499.05
|
| Rate for Payer: Dignity Health Media |
$4,499.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,499.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,117.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,117.20
|
| Rate for Payer: Galaxy Health WC |
$4,499.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,175.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,763.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,969.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,852.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,530.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,016.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.60
|
| Rate for Payer: Multiplan Commercial |
$3,969.75
|
| Rate for Payer: Networks By Design Commercial |
$3,440.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,499.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,117.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,175.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,499.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,499.05
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
|
IP
|
$5,293.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,058.60 |
| Max. Negotiated Rate |
$4,763.70 |
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,234.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,117.20
|
| Rate for Payer: Galaxy Health WC |
$4,499.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,175.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,763.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,530.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,016.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.60
|
| Rate for Payer: Multiplan Commercial |
$3,969.75
|
| Rate for Payer: Networks By Design Commercial |
$3,440.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,499.05
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
IP
|
$9,117.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,823.40 |
| Max. Negotiated Rate |
$8,205.30 |
| Rate for Payer: Cash Price |
$4,102.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,293.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,646.80
|
| Rate for Payer: Galaxy Health WC |
$7,749.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,470.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,205.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.40
|
| Rate for Payer: Multiplan Commercial |
$6,837.75
|
| Rate for Payer: Networks By Design Commercial |
$5,926.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,749.45
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
IP
|
$9,117.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,823.40 |
| Max. Negotiated Rate |
$8,205.30 |
| Rate for Payer: Cash Price |
$4,102.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,293.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,646.80
|
| Rate for Payer: Galaxy Health WC |
$7,749.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,470.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,205.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.40
|
| Rate for Payer: Multiplan Commercial |
$6,837.75
|
| Rate for Payer: Networks By Design Commercial |
$5,926.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,749.45
|
|
