|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
915350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Blue Shield of California Commercial |
$146.87
|
| Rate for Payer: Blue Shield of California EPN |
$95.76
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
915350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$77.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.59
|
| Rate for Payer: Blue Shield of California Commercial |
$146.87
|
| Rate for Payer: Blue Shield of California EPN |
$95.76
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$161.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.28
|
| Rate for Payer: InnovAge PACE Commercial |
$95.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Riverside University Health System MISP |
$76.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.50
|
| Rate for Payer: Vantage Medical Group Senior |
$161.50
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 100 SQCM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT C5277
|
| Hospital Charge Code |
900101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$777.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,287.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.31
|
| Rate for Payer: Blue Shield of California EPN |
$874.61
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Cigna of CA HMO |
$1,402.88
|
| Rate for Payer: Cigna of CA PPO |
$1,622.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 100 SQCM
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT C5277
|
| Hospital Charge Code |
900101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,356.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 25 SQCM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
900101513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$777.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,287.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.31
|
| Rate for Payer: Blue Shield of California EPN |
$874.61
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Cigna of CA HMO |
$1,402.88
|
| Rate for Payer: Cigna of CA PPO |
$1,622.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 25 SQCM
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
900101513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,356.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 100 SQCM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT C5278
|
| Hospital Charge Code |
900101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.09
|
| Rate for Payer: Blue Shield of California Commercial |
$669.04
|
| Rate for Payer: Blue Shield of California EPN |
$436.90
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: InnovAge PACE Commercial |
$547.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 100 SQCM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT C5278
|
| Hospital Charge Code |
900101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 25 SQCM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT C5276
|
| Hospital Charge Code |
900101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 25 SQCM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT C5276
|
| Hospital Charge Code |
900101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.09
|
| Rate for Payer: Blue Shield of California Commercial |
$669.04
|
| Rate for Payer: Blue Shield of California EPN |
$436.90
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: InnovAge PACE Commercial |
$547.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 100 SQCM
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
CPT C5273
|
| Hospital Charge Code |
900101511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.00 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,862.00
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,726.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,428.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 100 SQCM
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
CPT C5273
|
| Hospital Charge Code |
900101511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.00 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,324.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,464.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,202.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,371.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,854.84
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: Cigna of CA HMO |
$4,579.20
|
| Rate for Payer: Cigna of CA PPO |
$5,294.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,726.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,293.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,293.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,577.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 25 SQCM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
900101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$777.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,287.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.31
|
| Rate for Payer: Blue Shield of California EPN |
$874.61
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Cigna of CA HMO |
$1,402.88
|
| Rate for Payer: Cigna of CA PPO |
$1,622.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 25 SQCM
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
900101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,356.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 100 SQCM
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT C5274
|
| Hospital Charge Code |
900101512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.60 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,683.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,732.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,101.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Cigna of CA HMO |
$2,289.92
|
| Rate for Payer: Cigna of CA PPO |
$2,647.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,041.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,041.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,789.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,386.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,363.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,504.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,504.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,431.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,789.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,041.30
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 100 SQCM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT C5274
|
| Hospital Charge Code |
900101512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.60 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,386.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,363.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 25 SQCM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
900101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 25 SQCM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
900101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.09
|
| Rate for Payer: Blue Shield of California Commercial |
$669.04
|
| Rate for Payer: Blue Shield of California EPN |
$436.90
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: InnovAge PACE Commercial |
$547.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC LOWER EXT ARTERIAL EXAM, BILAT
|
Facility
|
IP
|
$1,724.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
908100113
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$1,551.60 |
| Rate for Payer: Adventist Health Commercial |
$344.80
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,379.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.60
|
| Rate for Payer: EPIC Health Plan Senior |
$689.60
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,551.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,067.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.80
|
| Rate for Payer: Multiplan Commercial |
$1,293.00
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
|
|
HC LOWER EXT ARTERIAL EXAM, BILAT
|
Facility
|
OP
|
$1,724.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
908100113
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$183.04 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$344.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,046.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$642.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,012.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,046.47
|
| Rate for Payer: Blue Shield of California EPN |
$684.43
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,379.20
|
| Rate for Payer: Cigna of CA HMO |
$1,103.36
|
| Rate for Payer: Cigna of CA PPO |
$1,275.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,551.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$1,293.00
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,034.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,034.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$484.20 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$295.90
|
| Rate for Payer: Central Health Plan Commercial |
$430.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Senior |
$215.20
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.60
|
| Rate for Payer: Multiplan Commercial |
$403.50
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$326.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$260.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$315.97
|
| Rate for Payer: Blue Shield of California Commercial |
$328.72
|
| Rate for Payer: Blue Shield of California EPN |
$214.66
|
| Rate for Payer: Cash Price |
$295.90
|
| Rate for Payer: Cash Price |
$295.90
|
| Rate for Payer: Cash Price |
$295.90
|
| Rate for Payer: Central Health Plan Commercial |
$430.40
|
| Rate for Payer: Cigna of CA HMO |
$344.32
|
| Rate for Payer: Cigna of CA PPO |
$398.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$403.50
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Central Health Plan Commercial |
$414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$466.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.60
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$314.43
|
| Rate for Payer: Blue Shield of California EPN |
$205.65
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Central Health Plan Commercial |
$414.40
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$466.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC LRNGSCPY, FLXBL W BX OR BXS
|
Facility
|
OP
|
$5,904.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
900500576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,180.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Cash Price |
$3,247.20
|
| Rate for Payer: Cash Price |
$3,247.20
|
| Rate for Payer: Cash Price |
$3,247.20
|
| Rate for Payer: Cash Price |
$3,247.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,723.20
|
| Rate for Payer: Cigna of CA HMO |
$3,778.56
|
| Rate for Payer: Cigna of CA PPO |
$4,368.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$5,018.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,313.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: InnovAge PACE Commercial |
$3,286.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,937.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,180.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,936.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$3,837.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,018.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,322.58
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,410.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,952.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
