|
HC RMVL FB PHARYNGEAL
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
|
|
HC RMVL F.B. UPPER ARM/ELBOW,SUBC
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
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 F.B. UPPER ARM/ELBOW,SUBC
|
Facility
|
OP
|
$1,645.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$329.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$210.08
|
| 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 FECAL IMPACTION W/ANESTHE
|
Facility
|
IP
|
$5,472.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
900501608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,094.40 |
| Max. Negotiated Rate |
$4,651.20 |
| Rate for Payer: Adventist Health Commercial |
$1,094.40
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,188.80
|
| Rate for Payer: Galaxy Health WC |
$4,651.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,283.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,649.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,084.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,387.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.28
|
| Rate for Payer: Multiplan Commercial |
$4,377.60
|
| Rate for Payer: Networks By Design Commercial |
$3,556.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,651.20
|
|
|
HC RMVL FECAL IMPACTION W/ANESTHE
|
Facility
|
OP
|
$5,472.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
900501608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.17 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,094.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cigna of CA HMO |
$3,502.08
|
| Rate for Payer: Cigna of CA PPO |
$4,049.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$4,651.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,283.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,649.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$4,377.60
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$3,556.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,651.20
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,736.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,736.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,736.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC RMVL FOREIGN BODY EYELID
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$635.71
|
| 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
|
450
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Cigna of CA HMO |
$657.28
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| 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 |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$513.50
|
| Rate for Payer: United Healthcare All Other HMO |
$513.50
|
| Rate for Payer: United Healthcare HMO Rider |
$513.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$513.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna of CA HMO |
$299.52
|
| Rate for Payer: Cigna of CA PPO |
$346.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| 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: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$289.69
|
| 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
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
|
OP
|
$1,091.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$218.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$600.05
|
| Rate for Payer: Cash Price |
$600.05
|
| Rate for Payer: Cash Price |
$600.05
|
| Rate for Payer: Cigna of CA HMO |
$698.24
|
| Rate for Payer: Cigna of CA PPO |
$807.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$927.35
|
| Rate for Payer: Global Benefits Group Commercial |
$654.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$872.80
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$709.15
|
| Rate for Payer: Prime Health Services Commercial |
$927.35
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$654.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$545.50
|
| Rate for Payer: United Healthcare All Other HMO |
$545.50
|
| Rate for Payer: United Healthcare HMO Rider |
$545.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$545.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
|
IP
|
$1,091.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.20 |
| Max. Negotiated Rate |
$927.35 |
| Rate for Payer: Adventist Health Commercial |
$218.20
|
| Rate for Payer: Cash Price |
$600.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.40
|
| Rate for Payer: EPIC Health Plan Senior |
$436.40
|
| Rate for Payer: Galaxy Health WC |
$927.35
|
| Rate for Payer: Global Benefits Group Commercial |
$654.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.84
|
| Rate for Payer: Multiplan Commercial |
$872.80
|
| Rate for Payer: Networks By Design Commercial |
$709.15
|
| Rate for Payer: Prime Health Services Commercial |
$927.35
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
IP
|
$3,724.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$3,165.40 |
| Rate for Payer: Adventist Health Commercial |
$744.80
|
| Rate for Payer: Cash Price |
$2,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,489.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,489.60
|
| Rate for Payer: Galaxy Health WC |
$3,165.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,234.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,483.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,418.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,305.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$893.76
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: Networks By Design Commercial |
$2,420.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,165.40
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
OP
|
$3,724.00
|
|
|
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: Adventist Health Commercial |
$744.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,048.20
|
| Rate for Payer: Cash Price |
$2,048.20
|
| Rate for Payer: Cash Price |
$2,048.20
|
| Rate for Payer: Cigna of CA HMO |
$2,383.36
|
| Rate for Payer: Cigna of CA PPO |
$2,755.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$3,165.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,234.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,483.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$893.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$2,420.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,165.40
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,234.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,862.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,862.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,862.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,862.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
IP
|
$9,197.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906820266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,839.40 |
| Max. Negotiated Rate |
$7,817.45 |
| Rate for Payer: Adventist Health Commercial |
$1,839.40
|
| Rate for Payer: Cash Price |
$5,058.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,678.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$5,692.94
|
| 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
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
IP
|
$8,990.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,798.00 |
| Max. Negotiated Rate |
$7,641.50 |
| Rate for Payer: Adventist Health Commercial |
$1,798.00
|
| Rate for Payer: Cash Price |
$4,944.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,596.00
|
| Rate for Payer: Galaxy Health WC |
$7,641.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,996.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,425.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,564.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,157.60
|
| Rate for Payer: Multiplan Commercial |
$7,192.00
|
| Rate for Payer: Networks By Design Commercial |
$5,843.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,641.50
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
OP
|
$9,197.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906820266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$1,839.40
|
| 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 |
$6,897.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,058.35
|
| Rate for Payer: Cash Price |
$5,058.35
|
| Rate for Payer: Cash Price |
$5,058.35
|
| Rate for Payer: Cigna of CA HMO |
$5,886.08
|
| 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 Medi-Cal |
$7,817.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,817.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,678.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.04
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$5,692.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,207.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,437.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,437.90
|
| 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 |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| 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 INTRA AORTIC BLLN AST DVC
|
Facility
|
OP
|
$8,990.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$1,798.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,641.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,944.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,742.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,944.50
|
| Rate for Payer: Cash Price |
$4,944.50
|
| Rate for Payer: Cash Price |
$4,944.50
|
| Rate for Payer: Cigna of CA HMO |
$5,753.60
|
| Rate for Payer: Cigna of CA PPO |
$6,652.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,641.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,641.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,641.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,596.00
|
| Rate for Payer: Galaxy Health WC |
$7,641.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,996.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,564.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,293.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,293.00
|
| Rate for Payer: Multiplan Commercial |
$7,192.00
|
| Rate for Payer: Networks By Design Commercial |
$5,843.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,641.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,394.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,641.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,641.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,641.50
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$246.40
|
| 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 |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cigna of CA HMO |
$788.48
|
| Rate for Payer: Cigna of CA PPO |
$911.68
|
| 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 |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| 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 |
$821.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| 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 |
$985.60
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.00
|
| Rate for Payer: United Healthcare All Other HMO |
$616.00
|
| Rate for Payer: United Healthcare HMO Rider |
$616.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.00
|
| 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 INTRANASAL FB
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$1,047.20 |
| Rate for Payer: Adventist Health Commercial |
$246.40
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$492.80
|
| Rate for Payer: Galaxy Health WC |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$762.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| Rate for Payer: Multiplan Commercial |
$985.60
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
|
|
HC RMVL INTRANASAL LESION
|
Facility
|
OP
|
$5,641.00
|
|
|
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: Adventist Health Commercial |
$1,128.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,102.55
|
| Rate for Payer: Cash Price |
$3,102.55
|
| Rate for Payer: Cash Price |
$3,102.55
|
| Rate for Payer: Cigna of CA HMO |
$3,610.24
|
| Rate for Payer: Cigna of CA PPO |
$4,174.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$4,794.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,384.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,762.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,353.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$4,512.80
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,666.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,794.85
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,384.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,820.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,820.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,820.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,820.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC RMVL INTRANASAL LESION
|
Facility
|
IP
|
$5,641.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,128.20 |
| Max. Negotiated Rate |
$4,794.85 |
| Rate for Payer: Adventist Health Commercial |
$1,128.20
|
| Rate for Payer: Cash Price |
$3,102.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,256.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,256.40
|
| Rate for Payer: Galaxy Health WC |
$4,794.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,384.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,762.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,149.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,491.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,353.84
|
| Rate for Payer: Multiplan Commercial |
$4,512.80
|
| Rate for Payer: Networks By Design Commercial |
$3,666.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,794.85
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
IP
|
$5,987.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,197.40 |
| Max. Negotiated Rate |
$5,088.95 |
| Rate for Payer: Adventist Health Commercial |
$1,197.40
|
| Rate for Payer: Cash Price |
$3,292.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,394.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,394.80
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,993.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,281.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,705.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Multiplan Commercial |
$4,789.60
|
| Rate for Payer: Networks By Design Commercial |
$3,891.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,088.95
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
OP
|
$5,987.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$6,757.85 |
| Rate for Payer: Adventist Health Commercial |
$1,197.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,292.85
|
| Rate for Payer: Cash Price |
$3,292.85
|
| Rate for Payer: Cash Price |
$3,292.85
|
| Rate for Payer: Cigna of CA HMO |
$3,831.68
|
| Rate for Payer: Cigna of CA PPO |
$4,430.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,993.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$4,789.60
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,891.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,088.95
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,592.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,993.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,993.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,993.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,993.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
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 |
$564.40 |
| Max. Negotiated Rate |
$2,398.70 |
| Rate for Payer: Adventist Health Commercial |
$564.40
|
| Rate for Payer: Cash Price |
$1,552.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$1,746.82
|
| 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 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 |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$564.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,552.10
|
| Rate for Payer: Cash Price |
$1,552.10
|
| Rate for Payer: Cash Price |
$1,552.10
|
| Rate for Payer: Cigna of CA HMO |
$1,806.08
|
| Rate for Payer: Cigna of CA PPO |
$2,088.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,353.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,230.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,230.63
|
| Rate for Payer: Galaxy Health WC |
$2,398.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,693.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,018.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,230.63
|
| 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 |
$1,230.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,550.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,649.04
|
| Rate for Payer: Multiplan Commercial |
$2,257.60
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$1,834.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,398.70
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| 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: Upland Medical Group Pediatric |
$1,230.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,230.63
|
|
