|
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 |
$2,709.85
|
| Rate for Payer: Cash Price |
$2,709.85
|
| Rate for Payer: Cash Price |
$2,709.85
|
| 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 |
$2,709.85
|
| 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
|
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 |
$5,129.85
|
| Rate for Payer: Cash Price |
$5,129.85
|
| Rate for Payer: Cash Price |
$5,129.85
|
| 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 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 |
$5,129.85
|
| 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 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 |
$251.35
|
| Rate for Payer: Cash Price |
$251.35
|
| Rate for Payer: Cash Price |
$251.35
|
| 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 |
$251.35
|
| 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
|
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 |
$5,465.90
|
| Rate for Payer: Cash Price |
$5,465.90
|
| Rate for Payer: Cash Price |
$5,465.90
|
| 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 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 |
$5,465.90
|
| 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
|
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 |
$5,465.90
|
| 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 |
$5,465.90
|
| Rate for Payer: Cash Price |
$5,465.90
|
| Rate for Payer: Cash Price |
$5,465.90
|
| 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
|
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 |
$5,465.90
|
| Rate for Payer: Cash Price |
$5,465.90
|
| Rate for Payer: Cash Price |
$5,465.90
|
| 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 |
$5,465.90
|
| 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
|
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 |
$5,465.90
|
| 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 |
$5,465.90
|
| Rate for Payer: Cash Price |
$5,465.90
|
| Rate for Payer: Cash Price |
$5,465.90
|
| 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 |
$543.95
|
| 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 |
$543.95
|
| Rate for Payer: Cash Price |
$543.95
|
| Rate for Payer: Cash Price |
$543.95
|
| 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
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906820139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cigna of CA HMO |
$2,128.00
|
| Rate for Payer: Cigna of CA PPO |
$2,460.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,660.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,995.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906820139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,826.25 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.00
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$2,660.00
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
IP
|
$3,421.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.20 |
| Max. Negotiated Rate |
$2,907.85 |
| Rate for Payer: Adventist Health Commercial |
$684.20
|
| Rate for Payer: Cash Price |
$1,881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,368.40
|
| Rate for Payer: Galaxy Health WC |
$2,907.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,052.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,281.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,303.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,117.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.04
|
| Rate for Payer: Multiplan Commercial |
$2,736.80
|
| Rate for Payer: Networks By Design Commercial |
$2,223.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,907.85
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
OP
|
$3,421.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$684.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$1,881.55
|
| Rate for Payer: Cash Price |
$1,881.55
|
| Rate for Payer: Cash Price |
$1,881.55
|
| Rate for Payer: Cigna of CA HMO |
$2,189.44
|
| Rate for Payer: Cigna of CA PPO |
$2,531.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,907.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,052.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,281.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,736.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,223.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,907.85
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,052.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
|
OP
|
$6,927.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$821.26 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,385.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$3,809.85
|
| Rate for Payer: Cash Price |
$3,809.85
|
| Rate for Payer: Cash Price |
$3,809.85
|
| Rate for Payer: Cigna of CA HMO |
$4,433.28
|
| Rate for Payer: Cigna of CA PPO |
$5,125.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$5,887.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,156.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,662.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$5,541.60
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$4,502.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,887.95
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,156.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,463.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,463.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,463.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,463.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
|
IP
|
$6,927.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,385.40 |
| Max. Negotiated Rate |
$5,887.95 |
| Rate for Payer: Adventist Health Commercial |
$1,385.40
|
| Rate for Payer: Cash Price |
$3,809.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,770.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,770.80
|
| Rate for Payer: Galaxy Health WC |
$5,887.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,156.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,639.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,287.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,662.48
|
| Rate for Payer: Multiplan Commercial |
$5,541.60
|
| Rate for Payer: Networks By Design Commercial |
$4,502.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,887.95
|
|
|
HC RMV SUPER/DEEP WIRE/PIN/SCREW
|
Facility
|
OP
|
$7,966.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
950510037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,593.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$4,381.30
|
| Rate for Payer: Cash Price |
$4,381.30
|
| Rate for Payer: Cash Price |
$4,381.30
|
| Rate for Payer: Cigna of CA HMO |
$5,098.24
|
| Rate for Payer: Cigna of CA PPO |
$5,894.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$6,771.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,779.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,911.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$6,372.80
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$5,177.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,771.10
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,779.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,983.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,983.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,983.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,983.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC RMV SUPER/DEEP WIRE/PIN/SCREW
|
Facility
|
IP
|
$7,966.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
950510037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$6,771.10 |
| Rate for Payer: Adventist Health Commercial |
$1,593.20
|
| Rate for Payer: Cash Price |
$4,381.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,186.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,186.40
|
| Rate for Payer: Galaxy Health WC |
$6,771.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,779.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,035.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,930.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,911.84
|
| Rate for Payer: Multiplan Commercial |
$6,372.80
|
| Rate for Payer: Networks By Design Commercial |
$5,177.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,771.10
|
|
|
HC RN ASSESSMENT 30 MIN
|
Facility
|
IP
|
$92.00
|
|
| Hospital Charge Code |
912904301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
|
