|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cigna of CA HMO |
$196.48
|
| Rate for Payer: Cigna of CA PPO |
$227.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$260.95
|
| Rate for Payer: Global Benefits Group Commercial |
$184.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$199.55
|
| Rate for Payer: Prime Health Services Commercial |
$260.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$125.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cigna of CA HMO |
$196.48
|
| Rate for Payer: Cigna of CA PPO |
$227.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$260.95
|
| Rate for Payer: Global Benefits Group Commercial |
$184.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$199.55
|
| Rate for Payer: Prime Health Services Commercial |
$260.95
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$355.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$887.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$520.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.00
|
| Rate for Payer: United Healthcare All Other HMO |
$434.00
|
| Rate for Payer: United Healthcare HMO Rider |
$434.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$718.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Senior |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$652.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$605.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$718.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Senior |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$652.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$605.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$421.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cigna of CA HMO |
$657.28
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$718.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$652.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cigna of CA HMO |
$657.28
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$718.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$652.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$513.50
|
| Rate for Payer: United Healthcare All Other HMO |
$513.50
|
| Rate for Payer: United Healthcare HMO Rider |
$513.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$513.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$899.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$835.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna of CA HMO |
$906.24
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$899.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$708.00
|
| Rate for Payer: United Healthcare All Other HMO |
$708.00
|
| Rate for Payer: United Healthcare HMO Rider |
$708.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$580.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$318.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna of CA HMO |
$906.24
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$899.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$849.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$899.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$835.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
IP
|
$1,213.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.60 |
| Max. Negotiated Rate |
$1,031.05 |
| Rate for Payer: Adventist Health Commercial |
$242.60
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.20
|
| Rate for Payer: EPIC Health Plan Senior |
$485.20
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$715.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.12
|
| Rate for Payer: Multiplan Commercial |
$970.40
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
OP
|
$1,213.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.60 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$242.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Cigna of CA HMO |
$776.32
|
| Rate for Payer: Cigna of CA PPO |
$897.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$970.40
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$727.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$606.50
|
| Rate for Payer: United Healthcare All Other HMO |
$606.50
|
| Rate for Payer: United Healthcare HMO Rider |
$606.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
OP
|
$1,213.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$249.72 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$497.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$249.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Cigna of CA HMO |
$776.32
|
| Rate for Payer: Cigna of CA PPO |
$897.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$970.40
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$727.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$727.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
IP
|
$1,213.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$242.60 |
| Max. Negotiated Rate |
$1,031.05 |
| Rate for Payer: Adventist Health Commercial |
$242.60
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.20
|
| Rate for Payer: EPIC Health Plan Senior |
$485.20
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$715.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.12
|
| Rate for Payer: Multiplan Commercial |
$970.40
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna of CA HMO |
$906.24
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$899.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$708.00
|
| Rate for Payer: United Healthcare All Other HMO |
$708.00
|
| Rate for Payer: United Healthcare HMO Rider |
$708.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Adventist Health Commercial |
$580.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna of CA HMO |
$906.24
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$899.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$849.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$899.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$835.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$899.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$835.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
OP
|
$7,687.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$453.42 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,537.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Cigna of CA HMO |
$4,919.68
|
| Rate for Payer: Cigna of CA PPO |
$5,688.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,380.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Galaxy Health WC |
$6,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,612.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,881.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$453.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,016.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,844.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$6,149.60
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$4,996.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,533.95
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,612.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,843.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,843.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,843.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,843.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
IP
|
$7,687.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,537.40 |
| Max. Negotiated Rate |
$6,533.95 |
| Rate for Payer: Adventist Health Commercial |
$1,537.40
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,380.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,074.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,074.80
|
| Rate for Payer: Galaxy Health WC |
$6,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,612.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,881.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,535.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,844.88
|
| Rate for Payer: Multiplan Commercial |
$6,149.60
|
| Rate for Payer: Networks By Design Commercial |
$4,996.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,533.95
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$695.30 |
| Rate for Payer: Adventist Health Commercial |
$163.60
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$572.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$519.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$482.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
|
