|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.40 |
| 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 |
$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 |
$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 |
$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 |
$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 |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| 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 |
$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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
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 F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
OP
|
$7,864.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$453.42 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,718.40
|
| Rate for Payer: Cash Price |
$3,538.80
|
| Rate for Payer: Cash Price |
$3,538.80
|
| Rate for Payer: Cash Price |
$3,538.80
|
| Rate for Payer: Cigna of CA PPO |
$5,819.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$6,684.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,718.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,898.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,822.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,822.43
|
| 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 |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,245.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,887.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$6,291.20
|
| Rate for Payer: Networks By Design Commercial |
$5,111.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,684.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,718.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,932.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,932.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,932.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
IP
|
$7,864.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,887.36 |
| Max. Negotiated Rate |
$6,684.40 |
| Rate for Payer: Cash Price |
$3,538.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,145.60
|
| Rate for Payer: Galaxy Health WC |
$6,684.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,718.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,245.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,996.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,887.36
|
| Rate for Payer: Multiplan Commercial |
$6,291.20
|
| Rate for Payer: Networks By Design Commercial |
$5,111.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,684.40
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.88 |
| 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 |
$502.20
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cigna of CA PPO |
$619.38
|
| 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 |
$711.45
|
| Rate for Payer: Global Benefits Group Commercial |
$502.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$627.75
|
| 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 |
$558.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.88
|
| 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 |
$669.60
|
| Rate for Payer: Networks By Design Commercial |
$544.05
|
| Rate for Payer: Prime Health Services Commercial |
$711.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$502.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.50
|
| Rate for Payer: United Healthcare All Other HMO |
$418.50
|
| Rate for Payer: United Healthcare HMO Rider |
$418.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.50
|
| 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 EXT AUDITORY CANAL
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.88 |
| Max. Negotiated Rate |
$711.45 |
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.80
|
| Rate for Payer: Galaxy Health WC |
$711.45
|
| Rate for Payer: Global Benefits Group Commercial |
$502.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.88
|
| Rate for Payer: Multiplan Commercial |
$669.60
|
| Rate for Payer: Networks By Design Commercial |
$544.05
|
| Rate for Payer: Prime Health Services Commercial |
$711.45
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
IP
|
$3,234.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$776.16 |
| Max. Negotiated Rate |
$2,748.90 |
| Rate for Payer: Cash Price |
$1,455.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,293.60
|
| Rate for Payer: Galaxy Health WC |
$2,748.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,940.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,232.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.16
|
| Rate for Payer: Multiplan Commercial |
$2,587.20
|
| Rate for Payer: Networks By Design Commercial |
$2,102.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,748.90
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
OP
|
$3,234.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.23 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,940.40
|
| Rate for Payer: Cash Price |
$1,455.30
|
| Rate for Payer: Cash Price |
$1,455.30
|
| Rate for Payer: Cash Price |
$1,455.30
|
| Rate for Payer: Cigna of CA PPO |
$2,393.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$2,748.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,940.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,425.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| 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 |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,587.20
|
| Rate for Payer: Networks By Design Commercial |
$2,102.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,748.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,940.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,617.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,617.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,617.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,617.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
OP
|
$7,945.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$696.77 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,767.00
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cigna of CA PPO |
$5,879.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,958.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| 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 |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$6,356.00
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,767.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,972.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,972.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,972.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
IP
|
$7,945.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,906.80 |
| Max. Negotiated Rate |
$6,753.25 |
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,178.00
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,027.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.80
|
| Rate for Payer: Multiplan Commercial |
$6,356.00
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$3,427.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,056.20
|
| Rate for Payer: Cash Price |
$1,542.15
|
| Rate for Payer: Cash Price |
$1,542.15
|
| Rate for Payer: Cash Price |
$1,542.15
|
| Rate for Payer: Cigna of CA PPO |
$2,535.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,912.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,056.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,570.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| 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 |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,285.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,741.60
|
| Rate for Payer: Networks By Design Commercial |
$2,227.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,912.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,056.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,713.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,713.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,713.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,713.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$3,427.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$822.48 |
| Max. Negotiated Rate |
$2,912.95 |
| Rate for Payer: Cash Price |
$1,542.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,370.80
|
| Rate for Payer: Galaxy Health WC |
$2,912.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,056.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,285.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,305.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.48
|
| Rate for Payer: Multiplan Commercial |
$2,741.60
|
| Rate for Payer: Networks By Design Commercial |
$2,227.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,912.95
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
IP
|
$4,301.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,032.24 |
| Max. Negotiated Rate |
$3,655.85 |
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,720.40
|
| Rate for Payer: Galaxy Health WC |
$3,655.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,580.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,868.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,638.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,032.24
|
| Rate for Payer: Multiplan Commercial |
$3,440.80
|
| Rate for Payer: Networks By Design Commercial |
$2,795.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,655.85
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
OP
|
$4,301.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$867.94 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,580.60
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Cigna of CA PPO |
$3,182.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$3,655.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,580.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,225.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,775.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,775.07
|
| 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 |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,868.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,032.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$3,440.80
|
| Rate for Payer: Networks By Design Commercial |
$2,795.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,655.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,580.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,150.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,150.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,150.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH DEEP
|
Facility
|
OP
|
$8,426.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
900501534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,055.60
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cigna of CA PPO |
$6,235.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$7,162.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,055.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,319.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,822.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,822.43
|
| 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 |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,620.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,022.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$6,740.80
|
| Rate for Payer: Networks By Design Commercial |
$5,476.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,162.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,055.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,213.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,213.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,213.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH DEEP
|
Facility
|
IP
|
$8,426.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
900501534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,022.24 |
| Max. Negotiated Rate |
$7,162.10 |
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,370.40
|
| Rate for Payer: Galaxy Health WC |
$7,162.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,055.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,620.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,210.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,022.24
|
| Rate for Payer: Multiplan Commercial |
$6,740.80
|
| Rate for Payer: Networks By Design Commercial |
$5,476.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,162.10
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH SMPL
|
Facility
|
OP
|
$1,935.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
900501492
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.62 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,161.00
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cigna of CA PPO |
$1,431.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$1,644.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,161.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,451.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| 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 |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$1,548.00
|
| Rate for Payer: Networks By Design Commercial |
$1,257.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,644.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$967.50
|
| Rate for Payer: United Healthcare All Other HMO |
$967.50
|
| Rate for Payer: United Healthcare HMO Rider |
$967.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$967.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH SMPL
|
Facility
|
IP
|
$1,935.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
900501492
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$1,644.75 |
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.00
|
| Rate for Payer: Galaxy Health WC |
$1,644.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,161.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Multiplan Commercial |
$1,548.00
|
| Rate for Payer: Networks By Design Commercial |
$1,257.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,644.75
|
|
|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
|
IP
|
$8,758.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,101.92 |
| Max. Negotiated Rate |
$7,444.30 |
| Rate for Payer: Cash Price |
$3,941.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,503.20
|
| Rate for Payer: Galaxy Health WC |
$7,444.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,254.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,336.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,101.92
|
| Rate for Payer: Multiplan Commercial |
$7,006.40
|
| Rate for Payer: Networks By Design Commercial |
$5,692.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,444.30
|
|
|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
|
OP
|
$8,758.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$7,444.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,254.80
|
| Rate for Payer: Cash Price |
$3,941.10
|
| Rate for Payer: Cash Price |
$3,941.10
|
| Rate for Payer: Cash Price |
$3,941.10
|
| Rate for Payer: Cigna of CA PPO |
$6,480.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$7,444.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,254.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,568.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| 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 |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,101.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$7,006.40
|
| Rate for Payer: Networks By Design Commercial |
$5,692.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,444.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,254.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,379.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,379.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,379.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RMVL FB PHARYNGEAL
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$561.60
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna of CA PPO |
$692.64
|
| 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 |
$795.60
|
| Rate for Payer: Global Benefits Group Commercial |
$561.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$702.00
|
| 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 |
$624.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.64
|
| 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 |
$748.80
|
| Rate for Payer: Networks By Design Commercial |
$608.40
|
| Rate for Payer: Prime Health Services Commercial |
$795.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$468.00
|
| Rate for Payer: United Healthcare All Other HMO |
$468.00
|
| Rate for Payer: United Healthcare HMO Rider |
$468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.00
|
| 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 PHARYNGEAL
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.40
|
| Rate for Payer: Galaxy Health WC |
$795.60
|
| Rate for Payer: Global Benefits Group Commercial |
$561.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$624.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.64
|
| Rate for Payer: Multiplan Commercial |
$748.80
|
| Rate for Payer: Networks By Design Commercial |
$608.40
|
| Rate for Payer: Prime Health Services Commercial |
$795.60
|
|
|
HC RMVL F.B. UPPER ARM/ELBOW,SUBC
|
Facility
|
IP
|
$1,935.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$1,644.75 |
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.00
|
| Rate for Payer: Galaxy Health WC |
$1,644.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,161.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Multiplan Commercial |
$1,548.00
|
| Rate for Payer: Networks By Design Commercial |
$1,257.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,644.75
|
|
|
HC RMVL F.B. UPPER ARM/ELBOW,SUBC
|
Facility
|
OP
|
$1,935.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.08 |
| 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 |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,161.00
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cigna of CA PPO |
$1,431.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$1,644.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,161.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,451.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| 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 |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$1,548.00
|
| Rate for Payer: Networks By Design Commercial |
$1,257.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,644.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$967.50
|
| Rate for Payer: United Healthcare All Other HMO |
$967.50
|
| Rate for Payer: United Healthcare HMO Rider |
$967.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$967.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RMVL FECAL IMPACTION W/ANESTHE
|
Facility
|
IP
|
$6,438.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
900501608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,545.12 |
| Max. Negotiated Rate |
$5,472.30 |
| Rate for Payer: Cash Price |
$2,897.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.20
|
| Rate for Payer: Galaxy Health WC |
$5,472.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,452.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,545.12
|
| Rate for Payer: Multiplan Commercial |
$5,150.40
|
| Rate for Payer: Networks By Design Commercial |
$4,184.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,472.30
|
|
