|
HC RIBS UNILATERAL
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.24 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.40
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
|
|
HC RIGHT HEART CATH
|
Facility
|
OP
|
$14,868.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,327.40 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,566.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,920.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Cigna of CA PPO |
$11,002.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$12,637.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,920.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,151.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,327.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,568.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$11,894.40
|
| Rate for Payer: Networks By Design Commercial |
$9,664.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,637.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,920.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$14,868.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,568.32 |
| Max. Negotiated Rate |
$12,637.80 |
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,947.20
|
| Rate for Payer: Galaxy Health WC |
$12,637.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,920.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,664.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,568.32
|
| Rate for Payer: Multiplan Commercial |
$11,894.40
|
| Rate for Payer: Networks By Design Commercial |
$9,664.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,637.80
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
|
IP
|
$846.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$203.04 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
|
OP
|
$846.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$203.04 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$554.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.05
|
| Rate for Payer: Blue Distinction Transplant |
$507.60
|
| Rate for Payer: Blue Shield of California Commercial |
$499.99
|
| Rate for Payer: Blue Shield of California EPN |
$396.77
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna of CA HMO |
$541.44
|
| Rate for Payer: Cigna of CA PPO |
$626.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.10
|
| Rate for Payer: Dignity Health Media |
$719.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$719.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$634.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$423.00
|
| Rate for Payer: United Healthcare All Other HMO |
$423.00
|
| Rate for Payer: United Healthcare HMO Rider |
$423.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$719.10
|
| Rate for Payer: Vantage Medical Group Senior |
$719.10
|
|
|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
|
IP
|
$7,286.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,748.64 |
| Max. Negotiated Rate |
$6,193.10 |
| Rate for Payer: Cash Price |
$3,278.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,914.40
|
| Rate for Payer: Galaxy Health WC |
$6,193.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,371.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,859.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,775.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,748.64
|
| Rate for Payer: Multiplan Commercial |
$5,828.80
|
| Rate for Payer: Networks By Design Commercial |
$4,735.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,193.10
|
|
|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
|
OP
|
$7,286.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,024.97 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,371.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$3,278.70
|
| Rate for Payer: Cash Price |
$3,278.70
|
| Rate for Payer: Cigna of CA PPO |
$5,391.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$6,193.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,371.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,464.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,551.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,551.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,859.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,748.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$5,828.80
|
| Rate for Payer: Networks By Design Commercial |
$4,735.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,193.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,371.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC RMVL BRONCH VALVE ADDL LOBES
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$843.84 |
| Max. Negotiated Rate |
$2,988.60 |
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.40
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,339.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$2,285.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
|
|
HC RMVL BRONCH VALVE ADDL LOBES
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.42 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,109.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cigna of CA PPO |
$2,601.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,637.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,435.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$2,285.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,109.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
|
OP
|
$6,733.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$370.67 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,039.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$3,029.85
|
| Rate for Payer: Cash Price |
$3,029.85
|
| Rate for Payer: Cigna of CA PPO |
$4,982.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Media |
$4,678.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$5,723.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,039.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,049.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,673.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,673.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$5,386.40
|
| Rate for Payer: Networks By Design Commercial |
$4,376.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,723.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,039.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
|
IP
|
$6,733.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,615.92 |
| Max. Negotiated Rate |
$5,723.05 |
| Rate for Payer: Cash Price |
$3,029.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,693.20
|
| Rate for Payer: Galaxy Health WC |
$5,723.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,039.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,565.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.92
|
| Rate for Payer: Multiplan Commercial |
$5,386.40
|
| Rate for Payer: Networks By Design Commercial |
$4,376.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,723.05
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
IP
|
$6,415.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
901200090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,539.60 |
| Max. Negotiated Rate |
$5,452.75 |
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,566.00
|
| Rate for Payer: Galaxy Health WC |
$5,452.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,849.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,444.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.60
|
| Rate for Payer: Multiplan Commercial |
$5,132.00
|
| Rate for Payer: Networks By Design Commercial |
$4,169.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,452.75
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
IP
|
$6,415.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,539.60 |
| Max. Negotiated Rate |
$5,452.75 |
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,566.00
|
| Rate for Payer: Galaxy Health WC |
$5,452.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,849.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,444.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.60
|
| Rate for Payer: Multiplan Commercial |
$5,132.00
|
| Rate for Payer: Networks By Design Commercial |
$4,169.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,452.75
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
OP
|
$6,415.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
901200090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.85 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,849.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: Cigna of CA PPO |
$4,747.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$5,452.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,849.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,811.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$5,132.00
|
| Rate for Payer: Networks By Design Commercial |
$4,169.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,452.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,849.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
OP
|
$6,415.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.85 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,849.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: Cigna of CA PPO |
$4,747.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$5,452.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,849.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,811.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$5,132.00
|
| Rate for Payer: Networks By Design Commercial |
$4,169.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,452.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,849.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$188.40
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna of CA PPO |
$232.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$235.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.00
|
| Rate for Payer: United Healthcare All Other HMO |
$157.00
|
| Rate for Payer: United Healthcare HMO Rider |
$157.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.36 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.04 |
| Max. Negotiated Rate |
$867.85 |
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.40
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.04
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$612.60
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cigna of CA PPO |
$755.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.50
|
| Rate for Payer: United Healthcare All Other HMO |
$510.50
|
| Rate for Payer: United Healthcare HMO Rider |
$510.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$616.20
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$770.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$513.50
|
| Rate for Payer: United Healthcare All Other HMO |
$513.50
|
| Rate for Payer: United Healthcare HMO Rider |
$513.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$513.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.84 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$849.60
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,062.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$708.00
|
| Rate for Payer: United Healthcare All Other HMO |
$708.00
|
| Rate for Payer: United Healthcare HMO Rider |
$708.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
IP
|
$1,213.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.12 |
| Max. Negotiated Rate |
$1,031.05 |
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.20
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.12
|
| Rate for Payer: Multiplan Commercial |
$970.40
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
OP
|
$1,213.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$727.80
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Cigna of CA PPO |
$897.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$909.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$970.40
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$727.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$606.50
|
| Rate for Payer: United Healthcare All Other HMO |
$606.50
|
| Rate for Payer: United Healthcare HMO Rider |
$606.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
