|
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 |
$283.20 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$876.50
|
| 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 |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna of CA HMO |
$906.24
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| 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 |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| 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: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
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 |
$242.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$242.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$667.15
|
| Rate for Payer: Cash Price |
$667.15
|
| Rate for Payer: Cash Price |
$667.15
|
| Rate for Payer: Cigna of CA HMO |
$776.32
|
| Rate for Payer: Cigna of CA PPO |
$897.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| 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 |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$970.40
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| 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: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
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 |
$242.60 |
| Max. Negotiated Rate |
$1,031.05 |
| Rate for Payer: Adventist Health Commercial |
$242.60
|
| Rate for Payer: Cash Price |
$667.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$750.85
|
| 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 W SLIT LAMP
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$876.50
|
| 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 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 |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna of CA HMO |
$906.24
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| 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 |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| 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: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
IP
|
$7,687.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,537.40 |
| Max. Negotiated Rate |
$6,533.95 |
| Rate for Payer: Adventist Health Commercial |
$1,537.40
|
| Rate for Payer: Cash Price |
$4,227.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,074.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,074.80
|
| Rate for Payer: Galaxy Health WC |
$6,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,612.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,928.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,758.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,844.88
|
| Rate for Payer: Multiplan Commercial |
$6,149.60
|
| Rate for Payer: Networks By Design Commercial |
$4,996.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,533.95
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
OP
|
$7,687.00
|
|
|
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: Adventist Health Commercial |
$1,537.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$4,227.85
|
| Rate for Payer: Cash Price |
$4,227.85
|
| Rate for Payer: Cash Price |
$4,227.85
|
| Rate for Payer: Cigna of CA HMO |
$4,919.68
|
| Rate for Payer: Cigna of CA PPO |
$5,688.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$6,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,612.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,844.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$6,149.60
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$4,996.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,533.95
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,612.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,843.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,843.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,843.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,843.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.88 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$163.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cigna of CA HMO |
$523.52
|
| Rate for Payer: Cigna of CA PPO |
$605.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.00
|
| Rate for Payer: United Healthcare All Other HMO |
$409.00
|
| Rate for Payer: United Healthcare HMO Rider |
$409.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$695.30 |
| Rate for Payer: Adventist Health Commercial |
$163.60
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
IP
|
$3,161.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$632.20 |
| Max. Negotiated Rate |
$2,686.85 |
| Rate for Payer: Adventist Health Commercial |
$632.20
|
| Rate for Payer: Cash Price |
$1,738.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,264.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,264.40
|
| Rate for Payer: Galaxy Health WC |
$2,686.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,896.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,108.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,204.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,956.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.64
|
| Rate for Payer: Multiplan Commercial |
$2,528.80
|
| Rate for Payer: Networks By Design Commercial |
$2,054.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,686.85
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
OP
|
$3,161.00
|
|
|
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: Adventist Health Commercial |
$632.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,738.55
|
| Rate for Payer: Cash Price |
$1,738.55
|
| Rate for Payer: Cash Price |
$1,738.55
|
| Rate for Payer: Cigna of CA HMO |
$2,023.04
|
| Rate for Payer: Cigna of CA PPO |
$2,339.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$2,686.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,896.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,108.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$2,528.80
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,054.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,686.85
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,896.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,580.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,580.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,580.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,580.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
OP
|
$6,753.00
|
|
|
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: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,714.15
|
| Rate for Payer: Cash Price |
$3,714.15
|
| Rate for Payer: Cash Price |
$3,714.15
|
| Rate for Payer: Cigna of CA HMO |
$4,321.92
|
| Rate for Payer: Cigna of CA PPO |
$4,997.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$5,402.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,051.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,376.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,376.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,376.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,376.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
IP
|
$6,753.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,350.60 |
| Max. Negotiated Rate |
$5,740.05 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Cash Price |
$3,714.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,701.20
|
| Rate for Payer: Galaxy Health WC |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,180.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| Rate for Payer: Multiplan Commercial |
$5,402.40
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$2,913.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$2,476.05 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,165.20
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,942.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,109.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,803.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.12
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,893.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$2,913.00
|
|
|
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: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: Cigna of CA HMO |
$1,864.32
|
| Rate for Payer: Cigna of CA PPO |
$2,155.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,942.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,893.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,747.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,456.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,456.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,456.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
OP
|
$4,301.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$860.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$860.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,365.55
|
| Rate for Payer: Cash Price |
$2,365.55
|
| Rate for Payer: Cash Price |
$2,365.55
|
| Rate for Payer: Cigna of CA HMO |
$2,752.64
|
| Rate for Payer: Cigna of CA PPO |
$3,182.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$3,655.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,580.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| 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 |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,032.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$3,440.80
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$2,795.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,655.85
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| 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: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
IP
|
$4,301.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$860.20 |
| Max. Negotiated Rate |
$3,655.85 |
| Rate for Payer: Adventist Health Commercial |
$860.20
|
| Rate for Payer: Cash Price |
$2,365.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,720.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$2,662.32
|
| 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 MSCLE/TNDN SHEATH DEEP
|
Facility
|
OP
|
$7,162.00
|
|
|
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: Adventist Health Commercial |
$1,432.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,939.10
|
| Rate for Payer: Cash Price |
$3,939.10
|
| Rate for Payer: Cash Price |
$3,939.10
|
| Rate for Payer: Cigna of CA HMO |
$4,583.68
|
| Rate for Payer: Cigna of CA PPO |
$5,299.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$6,087.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,297.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,777.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,718.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$5,729.60
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$4,655.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,087.70
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,581.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,581.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,581.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH DEEP
|
Facility
|
IP
|
$7,162.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
900501534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,432.40 |
| Max. Negotiated Rate |
$6,087.70 |
| Rate for Payer: Adventist Health Commercial |
$1,432.40
|
| Rate for Payer: Cash Price |
$3,939.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,864.80
|
| Rate for Payer: Galaxy Health WC |
$6,087.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,297.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,777.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,728.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,433.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,718.88
|
| Rate for Payer: Multiplan Commercial |
$5,729.60
|
| Rate for Payer: Networks By Design Commercial |
$4,655.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,087.70
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH SMPL
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
900501492
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.00 |
| Max. Negotiated Rate |
$1,398.25 |
| Rate for Payer: Adventist Health Commercial |
$329.00
|
| Rate for Payer: Cash Price |
$904.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.00
|
| Rate for Payer: EPIC Health Plan Senior |
$658.00
|
| Rate for Payer: Galaxy Health WC |
$1,398.25
|
| Rate for Payer: Global Benefits Group Commercial |
$987.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,018.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.80
|
| Rate for Payer: Multiplan Commercial |
$1,316.00
|
| Rate for Payer: Networks By Design Commercial |
$1,069.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,398.25
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH SMPL
|
Facility
|
OP
|
$1,645.00
|
|
|
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: Adventist Health Commercial |
$329.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$904.75
|
| Rate for Payer: Cash Price |
$904.75
|
| Rate for Payer: Cash Price |
$904.75
|
| Rate for Payer: Cigna of CA HMO |
$1,052.80
|
| Rate for Payer: Cigna of CA PPO |
$1,217.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$1,398.25
|
| Rate for Payer: Global Benefits Group Commercial |
$987.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$1,316.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,069.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,398.25
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$822.50
|
| Rate for Payer: United Healthcare All Other HMO |
$822.50
|
| Rate for Payer: United Healthcare HMO Rider |
$822.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$822.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
|
IP
|
$8,560.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,712.00 |
| Max. Negotiated Rate |
$7,276.00 |
| Rate for Payer: Adventist Health Commercial |
$1,712.00
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,424.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,424.00
|
| Rate for Payer: Galaxy Health WC |
$7,276.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,136.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,709.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,261.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,298.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.40
|
| Rate for Payer: Multiplan Commercial |
$6,848.00
|
| Rate for Payer: Networks By Design Commercial |
$5,564.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,276.00
|
|
|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
|
OP
|
$8,560.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$7,276.00 |
| Rate for Payer: Adventist Health Commercial |
$1,712.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Cigna of CA HMO |
$5,478.40
|
| Rate for Payer: Cigna of CA PPO |
$6,334.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$7,276.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,136.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,709.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$6,848.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,564.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,276.00
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,280.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,280.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,280.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,280.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC RMVL FB PHARYNGEAL
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cigna of CA HMO |
$509.44
|
| Rate for Payer: Cigna of CA PPO |
$589.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.00
|
| Rate for Payer: United Healthcare All Other HMO |
$398.00
|
| Rate for Payer: United Healthcare HMO Rider |
$398.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
