|
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 |
$4,045.50
|
| 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 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 |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| 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 |
$554.40
|
| 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
|
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 |
$2,538.45
|
| 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 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 |
$2,538.45
|
| Rate for Payer: Cash Price |
$2,538.45
|
| Rate for Payer: Cash Price |
$2,538.45
|
| 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 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 |
$2,694.15
|
| 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 |
$2,694.15
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cash Price |
$2,694.15
|
| 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
|
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 |
$1,269.90
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cash Price |
$1,269.90
|
| 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
|
|
|
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 |
$1,269.90
|
| 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 IMPLANT,SUPERFICIAL
|
Facility
|
OP
|
$4,927.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$985.40
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,217.15
|
| Rate for Payer: Cash Price |
$2,217.15
|
| Rate for Payer: Cash Price |
$2,217.15
|
| Rate for Payer: Cigna of CA HMO |
$3,153.28
|
| Rate for Payer: Cigna of CA PPO |
$3,645.98
|
| 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 |
$4,187.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,956.20
|
| 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 |
$3,286.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.48
|
| 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 |
$3,941.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,202.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,187.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,956.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,463.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,463.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,463.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,463.50
|
| 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 OF IMPLANT,SUPERFICIAL
|
Facility
|
IP
|
$4,927.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$985.40 |
| Max. Negotiated Rate |
$4,187.95 |
| Rate for Payer: Adventist Health Commercial |
$985.40
|
| Rate for Payer: Cash Price |
$2,217.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,970.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,970.80
|
| Rate for Payer: Galaxy Health WC |
$4,187.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,956.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,286.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,877.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,049.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.48
|
| Rate for Payer: Multiplan Commercial |
$3,941.60
|
| Rate for Payer: Networks By Design Commercial |
$3,202.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,187.95
|
|
|
HC RMVL OF IMPL FROM HAND
|
Facility
|
IP
|
$9,327.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
900501699
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,865.40 |
| Max. Negotiated Rate |
$7,927.95 |
| Rate for Payer: Adventist Health Commercial |
$1,865.40
|
| Rate for Payer: Cash Price |
$4,197.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,730.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,730.80
|
| Rate for Payer: Galaxy Health WC |
$7,927.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,596.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,221.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,553.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,773.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.48
|
| Rate for Payer: Multiplan Commercial |
$7,461.60
|
| Rate for Payer: Networks By Design Commercial |
$6,062.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,927.95
|
|
|
HC RMVL OF IMPL FROM HAND
|
Facility
|
OP
|
$9,327.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
900501699
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.94 |
| Max. Negotiated Rate |
$7,927.95 |
| Rate for Payer: Adventist Health Commercial |
$1,865.40
|
| 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 |
$4,197.15
|
| Rate for Payer: Cash Price |
$4,197.15
|
| Rate for Payer: Cash Price |
$4,197.15
|
| Rate for Payer: Cigna of CA HMO |
$5,969.28
|
| Rate for Payer: Cigna of CA PPO |
$6,901.98
|
| 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 |
$7,927.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,596.20
|
| 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 |
$6,221.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.48
|
| 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 |
$7,461.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$6,062.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,927.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,596.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,663.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,663.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,663.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,663.50
|
| 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 OF SKIN TAGS 1-15 LESIONS
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cigna of CA HMO |
$292.48
|
| Rate for Payer: Cigna of CA PPO |
$338.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.50
|
| Rate for Payer: United Healthcare All Other HMO |
$228.50
|
| Rate for Payer: United Healthcare HMO Rider |
$228.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC RMVL OF SKIN TAGS 1-15 LESIONS
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$388.45 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.80
|
| Rate for Payer: EPIC Health Plan Senior |
$182.80
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.68
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
|
|
HC RMVL PERM CCM DFIB SYS DUAL LEADS
|
Facility
|
IP
|
$9,938.00
|
|
|
Service Code
|
CPT 0922T
|
| Hospital Charge Code |
906811510
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,987.60 |
| Max. Negotiated Rate |
$8,447.30 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,975.20
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,151.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.12
|
| Rate for Payer: Multiplan Commercial |
$7,950.40
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
|
|
HC RMVL PERM CCM DFIB SYS DUAL LEADS
|
Facility
|
OP
|
$9,938.00
|
|
|
Service Code
|
CPT 0922T
|
| Hospital Charge Code |
906811510
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,102.93
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cigna of CA HMO |
$6,360.32
|
| Rate for Payer: Cigna of CA PPO |
$7,354.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,950.40
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,962.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC RMVL PERM CCM DFIB SYS PG ONLY
|
Facility
|
IP
|
$9,938.00
|
|
|
Service Code
|
CPT 0919T
|
| Hospital Charge Code |
906811507
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,987.60 |
| Max. Negotiated Rate |
$8,447.30 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,975.20
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,151.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.12
|
| Rate for Payer: Multiplan Commercial |
$7,950.40
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
|
|
HC RMVL PERM CCM DFIB SYS PG ONLY
|
Facility
|
OP
|
$9,938.00
|
|
|
Service Code
|
CPT 0919T
|
| Hospital Charge Code |
906811507
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,102.93
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cigna of CA HMO |
$6,360.32
|
| Rate for Payer: Cigna of CA PPO |
$7,354.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,950.40
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,962.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC RMVL PERM CCM DFIB SYS SINGLE DFB LEAD
|
Facility
|
IP
|
$9,938.00
|
|
|
Service Code
|
CPT 0921T
|
| Hospital Charge Code |
906811509
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,987.60 |
| Max. Negotiated Rate |
$8,447.30 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,975.20
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,151.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.12
|
| Rate for Payer: Multiplan Commercial |
$7,950.40
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
|
|
HC RMVL PERM CCM DFIB SYS SINGLE DFB LEAD
|
Facility
|
OP
|
$9,938.00
|
|
|
Service Code
|
CPT 0921T
|
| Hospital Charge Code |
906811509
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,102.93
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cigna of CA HMO |
$6,360.32
|
| Rate for Payer: Cigna of CA PPO |
$7,354.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,950.40
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,962.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC RMVL PERM CCM DFIB SYS SINGLE PAC LEAD
|
Facility
|
IP
|
$9,938.00
|
|
|
Service Code
|
CPT 0920T
|
| Hospital Charge Code |
906811508
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,987.60 |
| Max. Negotiated Rate |
$8,447.30 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,975.20
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,151.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.12
|
| Rate for Payer: Multiplan Commercial |
$7,950.40
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
|
|
HC RMVL PERM CCM DFIB SYS SINGLE PAC LEAD
|
Facility
|
OP
|
$9,938.00
|
|
|
Service Code
|
CPT 0920T
|
| Hospital Charge Code |
906811508
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,102.93
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cigna of CA HMO |
$6,360.32
|
| Rate for Payer: Cigna of CA PPO |
$7,354.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,950.40
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,962.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC RMVL REPAIR FULL ARM/LEG CAST
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
900501111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.80 |
| Max. Negotiated Rate |
$840.65 |
| Rate for Payer: Adventist Health Commercial |
$197.80
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.60
|
| Rate for Payer: EPIC Health Plan Senior |
$395.60
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$612.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$791.20
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
|
|
HC RMVL REPAIR FULL ARM/LEG CAST
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
900501111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$197.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cigna of CA HMO |
$632.96
|
| Rate for Payer: Cigna of CA PPO |
$731.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| Rate for Payer: Multiplan Commercial |
$791.20
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$593.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$494.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
