|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
905352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.02 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LOOPOGRAM (ILEAL CONDUIT)
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
909000207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.25
|
| 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 |
$273.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Media |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$341.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$159.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Riverside University Health System MISP |
$182.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| 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 Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC LOOPOGRAM (ILEAL CONDUIT)
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
909000207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
905350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Blue Shield of California EPN |
$379.14
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.10
|
| Rate for Payer: United Healthcare All Other HMO |
$261.85
|
| Rate for Payer: United Healthcare HMO Rider |
$256.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.30
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
905350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$343.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$419.47
|
| Rate for Payer: Blue Distinction Transplant |
$426.00
|
| Rate for Payer: Blue Shield of California Commercial |
$532.50
|
| Rate for Payer: Blue Shield of California EPN |
$386.24
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: Dignity Health Media |
$603.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$532.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$248.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.10
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Riverside University Health System MISP |
$284.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.00
|
| Rate for Payer: United Healthcare All Other HMO |
$355.00
|
| Rate for Payer: United Healthcare HMO Rider |
$355.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$355.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
IP
|
$9,608.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
905350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,921.60 |
| Max. Negotiated Rate |
$8,647.20 |
| Rate for Payer: Blue Shield of California EPN |
$5,130.67
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,686.40
|
| Rate for Payer: Cigna of CA HMO |
$6,725.60
|
| Rate for Payer: Cigna of CA PPO |
$6,725.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,843.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,843.20
|
| Rate for Payer: Galaxy Health WC |
$8,166.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,764.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,647.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,408.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,660.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,921.60
|
| Rate for Payer: Multiplan Commercial |
$7,206.00
|
| Rate for Payer: Networks By Design Commercial |
$4,804.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,627.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3,543.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3,466.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,170.64
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
OP
|
$9,608.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
905350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$8,647.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,166.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,284.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,284.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,652.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,676.41
|
| Rate for Payer: Blue Distinction Transplant |
$5,764.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,206.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,226.75
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,686.40
|
| Rate for Payer: Cigna of CA HMO |
$6,725.60
|
| Rate for Payer: Cigna of CA PPO |
$6,725.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,166.80
|
| Rate for Payer: Dignity Health Media |
$8,166.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,166.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,843.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,843.20
|
| Rate for Payer: Galaxy Health WC |
$8,166.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,764.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,647.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,206.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,362.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,408.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,939.28
|
| Rate for Payer: Multiplan Commercial |
$7,206.00
|
| Rate for Payer: Networks By Design Commercial |
$4,804.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,166.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,843.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,764.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,764.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,804.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,804.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,804.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,804.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,166.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,166.80
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 100 SQCM
|
Facility
|
OP
|
$1,657.00
|
|
|
Service Code
|
CPT C5277
|
| Hospital Charge Code |
900101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$802.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.96
|
| Rate for Payer: Blue Distinction Transplant |
$994.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.25
|
| Rate for Payer: Blue Shield of California EPN |
$810.27
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,325.60
|
| Rate for Payer: Cigna of CA HMO |
$1,060.48
|
| Rate for Payer: Cigna of CA PPO |
$1,226.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,491.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,242.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,294.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,242.75
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$994.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$994.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$828.50
|
| Rate for Payer: United Healthcare All Other HMO |
$828.50
|
| Rate for Payer: United Healthcare HMO Rider |
$828.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$828.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 100 SQCM
|
Facility
|
IP
|
$1,657.00
|
|
|
Service Code
|
CPT C5277
|
| Hospital Charge Code |
900101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$1,491.30 |
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,325.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.80
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,491.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.40
|
| Rate for Payer: Multiplan Commercial |
$1,242.75
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 25 SQCM
|
Facility
|
OP
|
$1,657.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
900101513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$802.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.96
|
| Rate for Payer: Blue Distinction Transplant |
$994.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.25
|
| Rate for Payer: Blue Shield of California EPN |
$810.27
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,325.60
|
| Rate for Payer: Cigna of CA HMO |
$1,060.48
|
| Rate for Payer: Cigna of CA PPO |
$1,226.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,491.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,242.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,294.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,242.75
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$994.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$994.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$828.50
|
| Rate for Payer: United Healthcare All Other HMO |
$828.50
|
| Rate for Payer: United Healthcare HMO Rider |
$828.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$828.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 25 SQCM
|
Facility
|
IP
|
$1,657.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
900101513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$1,491.30 |
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,325.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.80
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,491.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.40
|
| Rate for Payer: Multiplan Commercial |
$1,242.75
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 100 SQCM
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT C5278
|
| Hospital Charge Code |
900101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 100 SQCM
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT C5278
|
| Hospital Charge Code |
900101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$455.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$400.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.18
|
| Rate for Payer: Blue Distinction Transplant |
$496.80
|
| Rate for Payer: Blue Shield of California Commercial |
$520.81
|
| Rate for Payer: Blue Shield of California EPN |
$404.89
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$529.92
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Media |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$621.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Riverside University Health System MISP |
$331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 25 SQCM
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT C5276
|
| Hospital Charge Code |
900101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F ADD 25 SQCM
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT C5276
|
| Hospital Charge Code |
900101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$455.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$400.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.18
|
| Rate for Payer: Blue Distinction Transplant |
$496.80
|
| Rate for Payer: Blue Shield of California Commercial |
$520.81
|
| Rate for Payer: Blue Shield of California EPN |
$404.89
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$529.92
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Media |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$621.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Riverside University Health System MISP |
$331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 100 SQCM
|
Facility
|
OP
|
$5,410.00
|
|
|
Service Code
|
CPT C5273
|
| Hospital Charge Code |
900101511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,082.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,619.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,196.23
|
| Rate for Payer: Blue Distinction Transplant |
$3,246.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,402.89
|
| Rate for Payer: Blue Shield of California EPN |
$2,645.49
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,328.00
|
| Rate for Payer: Cigna of CA HMO |
$3,462.40
|
| Rate for Payer: Cigna of CA PPO |
$4,003.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,598.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,869.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,057.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,759.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,608.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,061.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$4,057.50
|
| Rate for Payer: Networks By Design Commercial |
$3,516.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,598.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,705.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,705.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,705.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,705.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 100 SQCM
|
Facility
|
IP
|
$5,410.00
|
|
|
Service Code
|
CPT C5273
|
| Hospital Charge Code |
900101511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,082.00 |
| Max. Negotiated Rate |
$4,869.00 |
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,328.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,164.00
|
| Rate for Payer: Galaxy Health WC |
$4,598.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,869.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,608.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,061.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.00
|
| Rate for Payer: Multiplan Commercial |
$4,057.50
|
| Rate for Payer: Networks By Design Commercial |
$3,516.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,598.50
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 25 SQCM
|
Facility
|
OP
|
$1,657.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
900101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$802.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.96
|
| Rate for Payer: Blue Distinction Transplant |
$994.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.25
|
| Rate for Payer: Blue Shield of California EPN |
$810.27
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,325.60
|
| Rate for Payer: Cigna of CA HMO |
$1,060.48
|
| Rate for Payer: Cigna of CA PPO |
$1,226.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,491.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,242.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,294.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,242.75
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$994.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$994.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$828.50
|
| Rate for Payer: United Healthcare All Other HMO |
$828.50
|
| Rate for Payer: United Healthcare HMO Rider |
$828.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$828.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC LOW COST SKIN SUB T/A/L 1ST 25 SQCM
|
Facility
|
IP
|
$1,657.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
900101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$1,491.30 |
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,325.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.80
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,491.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.40
|
| Rate for Payer: Multiplan Commercial |
$1,242.75
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 100 SQCM
|
Facility
|
IP
|
$2,705.00
|
|
|
Service Code
|
CPT C5274
|
| Hospital Charge Code |
900101512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$2,434.50 |
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,030.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 100 SQCM
|
Facility
|
OP
|
$2,705.00
|
|
|
Service Code
|
CPT C5274
|
| Hospital Charge Code |
900101512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,299.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,487.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,487.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,309.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,598.11
|
| Rate for Payer: Blue Distinction Transplant |
$1,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,701.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,322.74
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,731.20
|
| Rate for Payer: Cigna of CA PPO |
$2,001.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,299.25
|
| Rate for Payer: Dignity Health Media |
$2,299.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,299.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,028.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$946.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,030.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,082.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,623.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,623.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,352.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,352.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,352.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,299.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,299.25
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 25 SQCM
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
900101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 25 SQCM
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
900101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$455.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$400.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.18
|
| Rate for Payer: Blue Distinction Transplant |
$496.80
|
| Rate for Payer: Blue Shield of California Commercial |
$520.81
|
| Rate for Payer: Blue Shield of California EPN |
$404.89
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$529.92
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Media |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$621.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Riverside University Health System MISP |
$331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC LOWER EXT ARTERIAL EXAM, BILAT
|
Facility
|
OP
|
$1,452.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
908100113
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,144.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$642.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$857.84
|
| Rate for Payer: Blue Distinction Transplant |
$871.20
|
| Rate for Payer: Blue Shield of California Commercial |
$897.34
|
| Rate for Payer: Blue Shield of California EPN |
$705.67
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,161.60
|
| Rate for Payer: Cigna of CA HMO |
$929.28
|
| Rate for Payer: Cigna of CA PPO |
$1,074.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$1,234.20
|
| Rate for Payer: Global Benefits Group Commercial |
$871.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,306.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,089.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$968.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$1,089.00
|
| Rate for Payer: Networks By Design Commercial |
$943.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,234.20
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$871.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$871.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC LOWER EXT ARTERIAL EXAM, BILAT
|
Facility
|
IP
|
$1,452.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
908100113
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$290.40 |
| Max. Negotiated Rate |
$1,306.80 |
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,161.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.80
|
| Rate for Payer: Galaxy Health WC |
$1,234.20
|
| Rate for Payer: Global Benefits Group Commercial |
$871.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,306.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$968.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.40
|
| Rate for Payer: Multiplan Commercial |
$1,089.00
|
| Rate for Payer: Networks By Design Commercial |
$943.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,234.20
|
|
