|
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
|
|
|
HC RMVL FOREIGN BODY EYELID
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
490
|
| 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 FOREIGN BODY EYELID
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$103.99 |
| 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 |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$616.20
|
| Rate for Payer: Blue Shield of California Commercial |
$756.90
|
| Rate for Payer: Blue Shield of California EPN |
$599.77
|
| 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 |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| 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 |
$596.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$589.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$589.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| 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: TriValley Medical Group Commercial/Senior |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.20 |
| 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 |
$371.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Media |
$247.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$405.88
|
| 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 |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.01 |
| 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 |
$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 |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$669.60
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna of CA PPO |
$825.84
|
| 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 |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$837.00
|
| 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 |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| 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 |
$892.80
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO |
$558.00
|
| Rate for Payer: United Healthcare HMO Rider |
$558.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| 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 IMPACTED VAGINAL FB
|
Facility
|
IP
|
$4,612.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,106.88 |
| Max. Negotiated Rate |
$3,920.20 |
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,844.80
|
| Rate for Payer: Galaxy Health WC |
$3,920.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,767.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,076.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,757.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,106.88
|
| Rate for Payer: Multiplan Commercial |
$3,689.60
|
| Rate for Payer: Networks By Design Commercial |
$2,997.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,920.20
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
OP
|
$4,612.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.51 |
| 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 |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,767.20
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cigna of CA PPO |
$3,412.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$3,920.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,767.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,459.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| 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 |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,076.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,106.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$3,689.60
|
| Rate for Payer: Networks By Design Commercial |
$2,997.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,920.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,767.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,306.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,306.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,306.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,306.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
IP
|
$9,197.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,207.28 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,678.80
|
| Rate for Payer: Galaxy Health WC |
$7,817.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,518.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,504.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,207.28
|
| Rate for Payer: Multiplan Commercial |
$7,357.60
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,817.45
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
OP
|
$9,197.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$50.94 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,817.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,058.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,058.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,518.20
|
| 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 |
$4,138.65
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cigna of CA PPO |
$6,805.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,817.45
|
| Rate for Payer: Dignity Health Media |
$7,817.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,817.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,678.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,678.80
|
| Rate for Payer: Galaxy Health WC |
$7,817.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,518.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,897.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,207.28
|
| Rate for Payer: Multiplan Commercial |
$7,357.60
|
| Rate for Payer: Networks By Design Commercial |
$5,978.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,817.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,518.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,817.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,817.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,817.45
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.82 |
| 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 |
$869.40
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cigna of CA PPO |
$1,072.26
|
| 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 |
$1,231.65
|
| Rate for Payer: Global Benefits Group Commercial |
$869.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,086.75
|
| 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 |
$966.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.76
|
| 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 |
$1,159.20
|
| Rate for Payer: Networks By Design Commercial |
$941.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,231.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$869.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$724.50
|
| Rate for Payer: United Healthcare All Other HMO |
$724.50
|
| Rate for Payer: United Healthcare HMO Rider |
$724.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.50
|
| 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 INTRANASAL FB
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.76 |
| Max. Negotiated Rate |
$1,231.65 |
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.60
|
| Rate for Payer: Galaxy Health WC |
$1,231.65
|
| Rate for Payer: Global Benefits Group Commercial |
$869.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$966.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.76
|
| Rate for Payer: Multiplan Commercial |
$1,159.20
|
| Rate for Payer: Networks By Design Commercial |
$941.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,231.65
|
|
|
HC RMVL INTRANASAL LESION
|
Facility
|
OP
|
$5,771.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$431.49 |
| 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 |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,462.60
|
| Rate for Payer: Cash Price |
$2,596.95
|
| Rate for Payer: Cash Price |
$2,596.95
|
| Rate for Payer: Cash Price |
$2,596.95
|
| Rate for Payer: Cigna of CA PPO |
$4,270.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$4,905.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,462.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,328.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| 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 |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,849.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,385.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$4,616.80
|
| Rate for Payer: Networks By Design Commercial |
$3,751.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,905.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,462.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC RMVL INTRANASAL LESION
|
Facility
|
IP
|
$5,771.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,385.04 |
| Max. Negotiated Rate |
$4,905.35 |
| Rate for Payer: Cash Price |
$2,596.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,308.40
|
| Rate for Payer: Galaxy Health WC |
$4,905.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,849.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,198.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,385.04
|
| Rate for Payer: Multiplan Commercial |
$4,616.80
|
| Rate for Payer: Networks By Design Commercial |
$3,751.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,905.35
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
OP
|
$6,125.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$6,597.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,675.00
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Cigna of CA PPO |
$4,532.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$5,206.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,675.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,593.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| 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 |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,085.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$4,900.00
|
| Rate for Payer: Networks By Design Commercial |
$3,981.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,206.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,062.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
IP
|
$6,125.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$5,206.25 |
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,450.00
|
| Rate for Payer: Galaxy Health WC |
$5,206.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,085.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,333.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.00
|
| Rate for Payer: Multiplan Commercial |
$4,900.00
|
| Rate for Payer: Networks By Design Commercial |
$3,981.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,206.25
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
OP
|
$2,822.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| 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 |
$1,897.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,693.20
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cigna of CA PPO |
$2,088.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Media |
$1,264.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,707.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,264.97
|
| Rate for Payer: Galaxy Health WC |
$2,398.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,693.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,116.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,074.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,074.55
|
| 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 |
$1,264.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,882.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,593.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,695.06
|
| Rate for Payer: Multiplan Commercial |
$2,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,834.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,398.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,693.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,411.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,411.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
IP
|
$2,822.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$677.28 |
| Max. Negotiated Rate |
$2,398.70 |
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.80
|
| Rate for Payer: Galaxy Health WC |
$2,398.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,693.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,882.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.28
|
| Rate for Payer: Multiplan Commercial |
$2,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,834.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,398.70
|
|
|
HC RMVL OF IMPLANT,SUPERFICIAL
|
Facility
|
OP
|
$8,089.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$6,875.65 |
| 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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,853.40
|
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Cigna of CA PPO |
$5,985.86
|
| 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 |
$6,875.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,853.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,066.75
|
| 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 |
$5,395.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,941.36
|
| 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 |
$6,471.20
|
| Rate for Payer: Networks By Design Commercial |
$5,257.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,875.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,044.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,044.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,044.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,044.50
|
| 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 OF IMPLANT,SUPERFICIAL
|
Facility
|
IP
|
$8,089.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,941.36 |
| Max. Negotiated Rate |
$6,875.65 |
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,235.60
|
| Rate for Payer: Galaxy Health WC |
$6,875.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,853.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,395.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,081.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,941.36
|
| Rate for Payer: Multiplan Commercial |
$6,471.20
|
| Rate for Payer: Networks By Design Commercial |
$5,257.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,875.65
|
|
|
HC RMVL OF IMPL FROM HAND
|
Facility
|
IP
|
$9,542.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
900501699
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,290.08 |
| Max. Negotiated Rate |
$8,110.70 |
| Rate for Payer: Cash Price |
$4,293.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,816.80
|
| Rate for Payer: Galaxy Health WC |
$8,110.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,725.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,364.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,635.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,290.08
|
| Rate for Payer: Multiplan Commercial |
$7,633.60
|
| Rate for Payer: Networks By Design Commercial |
$6,202.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,110.70
|
|
|
HC RMVL OF IMPL FROM HAND
|
Facility
|
OP
|
$9,542.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
900501699
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.94 |
| Max. Negotiated Rate |
$8,110.70 |
| 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 |
$5,725.20
|
| Rate for Payer: Cash Price |
$4,293.90
|
| Rate for Payer: Cash Price |
$4,293.90
|
| Rate for Payer: Cash Price |
$4,293.90
|
| Rate for Payer: Cigna of CA PPO |
$7,061.08
|
| 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 |
$8,110.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,725.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,156.50
|
| 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 |
$6,364.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,290.08
|
| 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 |
$7,633.60
|
| Rate for Payer: Networks By Design Commercial |
$6,202.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,110.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,725.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,771.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,771.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,771.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,771.00
|
| 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 OF SKIN TAGS 1-15 LESIONS
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.14 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$280.80
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna of CA PPO |
$346.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$351.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| 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 |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.00
|
| Rate for Payer: United Healthcare All Other HMO |
$234.00
|
| Rate for Payer: United Healthcare HMO Rider |
$234.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC RMVL OF SKIN TAGS 1-15 LESIONS
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.32
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
|
