|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
IP
|
$2,163.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$1,946.70 |
| Rate for Payer: Adventist Health Commercial |
$432.60
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,730.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,514.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$865.20
|
| Rate for Payer: EPIC Health Plan Senior |
$865.20
|
| Rate for Payer: Galaxy Health WC |
$1,838.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,946.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,373.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,276.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.60
|
| Rate for Payer: Multiplan Commercial |
$1,622.25
|
| Rate for Payer: Networks By Design Commercial |
$1,405.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,838.55
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
OP
|
$2,163.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$886.83
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,783.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,730.40
|
| Rate for Payer: Cigna of CA HMO |
$1,384.32
|
| Rate for Payer: Cigna of CA PPO |
$1,600.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,514.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$1,838.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,946.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,373.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$744.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$1,622.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,405.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,838.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
OP
|
$2,163.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$432.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,730.40
|
| Rate for Payer: Cigna of CA HMO |
$1,384.32
|
| Rate for Payer: Cigna of CA PPO |
$1,600.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,514.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$1,838.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,946.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,373.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$744.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$1,622.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,405.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,838.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,081.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,081.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,081.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$2,007.90 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,007.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Multiplan Commercial |
$1,673.25
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.46 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| Rate for Payer: Cigna of CA HMO |
$1,427.84
|
| Rate for Payer: Cigna of CA PPO |
$1,650.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,007.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,673.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,338.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$2,007.90 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,007.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Multiplan Commercial |
$1,673.25
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$245.46 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$914.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,549.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| Rate for Payer: Cigna of CA HMO |
$1,427.84
|
| Rate for Payer: Cigna of CA PPO |
$1,650.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,007.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,673.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,338.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,338.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$324.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Cigna of CA HMO |
$1,038.72
|
| Rate for Payer: Cigna of CA PPO |
$1,201.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,136.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,030.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$628.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.50
|
| Rate for Payer: United Healthcare All Other HMO |
$811.50
|
| Rate for Payer: United Healthcare HMO Rider |
$811.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
|
IP
|
$1,623.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,460.70 |
| Rate for Payer: Adventist Health Commercial |
$324.60
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,136.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$649.20
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,030.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$957.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$665.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,376.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Cigna of CA HMO |
$1,038.72
|
| Rate for Payer: Cigna of CA PPO |
$1,201.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,136.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,030.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$628.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$973.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
|
IP
|
$1,623.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,460.70 |
| Rate for Payer: Adventist Health Commercial |
$324.60
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,136.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$649.20
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,030.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$957.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
|
IP
|
$2,926.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$2,633.40 |
| Rate for Payer: Adventist Health Commercial |
$585.20
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.40
|
| Rate for Payer: Galaxy Health WC |
$2,487.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,633.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,858.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,726.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.20
|
| Rate for Payer: Multiplan Commercial |
$2,194.50
|
| Rate for Payer: Networks By Design Commercial |
$1,901.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.10
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
|
IP
|
$2,926.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$2,633.40 |
| Rate for Payer: Adventist Health Commercial |
$585.20
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.40
|
| Rate for Payer: Galaxy Health WC |
$2,487.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,633.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,858.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,726.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.20
|
| Rate for Payer: Multiplan Commercial |
$2,194.50
|
| Rate for Payer: Networks By Design Commercial |
$1,901.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.10
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
|
OP
|
$2,926.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$585.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.80
|
| Rate for Payer: Cigna of CA HMO |
$1,872.64
|
| Rate for Payer: Cigna of CA PPO |
$2,165.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$2,487.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,633.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,858.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$2,194.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,901.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,463.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,463.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,463.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
|
OP
|
$2,926.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,199.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,378.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.80
|
| Rate for Payer: Cigna of CA HMO |
$1,872.64
|
| Rate for Payer: Cigna of CA PPO |
$2,165.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$2,487.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,633.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,858.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$2,194.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,901.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,976.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,729.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$988.00
|
| Rate for Payer: EPIC Health Plan Senior |
$988.00
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,223.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,568.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,457.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.00
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,099.50
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,976.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,729.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$988.00
|
| Rate for Payer: EPIC Health Plan Senior |
$988.00
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,223.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,568.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,457.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.00
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,099.50
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,976.00
|
| Rate for Payer: Cigna of CA HMO |
$1,580.80
|
| Rate for Payer: Cigna of CA PPO |
$1,827.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,729.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,223.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,568.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,482.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,235.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,012.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,643.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,976.00
|
| Rate for Payer: Cigna of CA HMO |
$1,580.80
|
| Rate for Payer: Cigna of CA PPO |
$1,827.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,729.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,223.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,568.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,482.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,482.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$710.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,840.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,386.40
|
| Rate for Payer: Cigna of CA HMO |
$1,109.12
|
| Rate for Payer: Cigna of CA PPO |
$1,282.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,213.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,473.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,559.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,299.75
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,126.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,473.05
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,039.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$346.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,386.40
|
| Rate for Payer: Cigna of CA HMO |
$1,109.12
|
| Rate for Payer: Cigna of CA PPO |
$1,282.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,213.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,473.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,559.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,299.75
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,126.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,473.05
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.50
|
| Rate for Payer: United Healthcare All Other HMO |
$866.50
|
| Rate for Payer: United Healthcare HMO Rider |
$866.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
IP
|
$1,733.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$346.60 |
| Max. Negotiated Rate |
$1,559.70 |
| Rate for Payer: Adventist Health Commercial |
$346.60
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,213.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$693.20
|
| Rate for Payer: Galaxy Health WC |
$1,473.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,559.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,022.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.60
|
| Rate for Payer: Multiplan Commercial |
$1,299.75
|
| Rate for Payer: Networks By Design Commercial |
$1,126.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,473.05
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
IP
|
$1,733.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.60 |
| Max. Negotiated Rate |
$1,559.70 |
| Rate for Payer: Adventist Health Commercial |
$346.60
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,213.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$693.20
|
| Rate for Payer: Galaxy Health WC |
$1,473.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,559.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,022.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.60
|
| Rate for Payer: Multiplan Commercial |
$1,299.75
|
| Rate for Payer: Networks By Design Commercial |
$1,126.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,473.05
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
OP
|
$3,494.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$698.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,795.20
|
| Rate for Payer: Cigna of CA HMO |
$2,236.16
|
| Rate for Payer: Cigna of CA PPO |
$2,585.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,445.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$2,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,096.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,144.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,218.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$698.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$2,620.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$2,271.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,969.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,096.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,747.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,747.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,747.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
IP
|
$3,494.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$698.80 |
| Max. Negotiated Rate |
$3,144.60 |
| Rate for Payer: Adventist Health Commercial |
$698.80
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,795.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,445.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,397.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,397.60
|
| Rate for Payer: Galaxy Health WC |
$2,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,096.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,144.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,218.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,061.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$698.80
|
| Rate for Payer: Multiplan Commercial |
$2,620.50
|
| Rate for Payer: Networks By Design Commercial |
$2,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,969.90
|
|
