|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$163.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$369.16
|
| 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 |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna of CA HMO |
$523.52
|
| Rate for Payer: Cigna of CA PPO |
$605.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$572.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$519.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| 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 |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.00
|
| Rate for Payer: United Healthcare All Other HMO |
$409.00
|
| Rate for Payer: United Healthcare HMO Rider |
$409.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 EXT AUDITORY CANAL
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$140.88 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna of CA HMO |
$523.52
|
| Rate for Payer: Cigna of CA PPO |
$605.32
|
| Rate for Payer: Adventist Health Commercial |
$335.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$369.16
|
| 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: 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 |
$572.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| 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 |
$519.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| 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 |
$654.40
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.80
|
| 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 |
$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 EXT AUDITORY CANAL
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
456
|
| 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
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.88 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$163.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna of CA HMO |
$523.52
|
| Rate for Payer: Cigna of CA PPO |
$605.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$572.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| 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 |
$519.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| 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 |
$654.40
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.00
|
| Rate for Payer: United Healthcare All Other HMO |
$409.00
|
| Rate for Payer: United Healthcare HMO Rider |
$409.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 F.B. FOOT, COMPLICATED
|
Facility
|
OP
|
$3,161.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.23 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$632.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,422.45
|
| Rate for Payer: Cash Price |
$1,422.45
|
| Rate for Payer: Cash Price |
$1,422.45
|
| Rate for Payer: Cigna of CA HMO |
$2,023.04
|
| Rate for Payer: Cigna of CA PPO |
$2,339.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,212.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$2,686.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,896.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,007.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,528.80
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,054.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,686.85
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,896.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,580.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,580.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,580.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,580.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
IP
|
$3,161.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$632.20 |
| Max. Negotiated Rate |
$2,686.85 |
| Rate for Payer: Networks By Design Commercial |
$2,054.65
|
| Rate for Payer: Adventist Health Commercial |
$632.20
|
| Rate for Payer: Cash Price |
$1,422.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,212.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,264.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,264.40
|
| Rate for Payer: Galaxy Health WC |
$2,686.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,896.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,007.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,864.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.64
|
| Rate for Payer: Multiplan Commercial |
$2,528.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,686.85
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
OP
|
$6,753.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$696.77 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Cigna of CA HMO |
$4,321.92
|
| Rate for Payer: Cigna of CA PPO |
$4,997.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,727.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,288.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$696.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$5,402.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,051.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,376.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,376.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,376.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,376.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
IP
|
$6,753.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,350.60 |
| Max. Negotiated Rate |
$5,740.05 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,727.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,701.20
|
| Rate for Payer: Galaxy Health WC |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,288.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,984.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| Rate for Payer: Multiplan Commercial |
$5,402.40
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$2,913.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$2,476.05 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,039.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,165.20
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,849.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,718.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.12
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,893.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$2,913.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$2,476.05 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,039.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,165.20
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,849.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,718.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.12
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,893.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$2,913.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,194.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$867.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cigna of CA HMO |
$1,864.32
|
| Rate for Payer: Cigna of CA PPO |
$2,155.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,039.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,849.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,893.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,747.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,747.80
|
| 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 |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$2,913.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cigna of CA HMO |
$1,864.32
|
| Rate for Payer: Cigna of CA PPO |
$2,155.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,039.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,849.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,893.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,747.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,456.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,456.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,456.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
OP
|
$4,301.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,763.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,235.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Cigna of CA HMO |
$2,752.64
|
| Rate for Payer: Cigna of CA PPO |
$3,182.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,010.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$3,655.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,580.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,731.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$867.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,032.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$3,440.80
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$2,795.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,655.85
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,580.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,580.60
|
| 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 |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
IP
|
$4,301.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$860.20 |
| Max. Negotiated Rate |
$3,655.85 |
| Rate for Payer: Adventist Health Commercial |
$860.20
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,010.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,720.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,720.40
|
| Rate for Payer: Galaxy Health WC |
$3,655.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,580.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,731.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,537.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,032.24
|
| Rate for Payer: Multiplan Commercial |
$3,440.80
|
| Rate for Payer: Networks By Design Commercial |
$2,795.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,655.85
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
IP
|
$4,301.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$860.20 |
| Max. Negotiated Rate |
$3,655.85 |
| Rate for Payer: Adventist Health Commercial |
$860.20
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,010.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,720.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,720.40
|
| Rate for Payer: Galaxy Health WC |
$3,655.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,580.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,731.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,537.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,032.24
|
| Rate for Payer: Multiplan Commercial |
$3,440.80
|
| Rate for Payer: Networks By Design Commercial |
$2,795.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,655.85
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
OP
|
$4,301.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$860.20 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$860.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Cash Price |
$1,935.45
|
| Rate for Payer: Cigna of CA HMO |
$2,752.64
|
| Rate for Payer: Cigna of CA PPO |
$3,182.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,010.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$3,655.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,580.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,731.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$867.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,032.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$3,440.80
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$2,795.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,655.85
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,580.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,150.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,150.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,150.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH DEEP
|
Facility
|
IP
|
$7,162.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
900501534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,432.40 |
| Max. Negotiated Rate |
$6,087.70 |
| Rate for Payer: Adventist Health Commercial |
$1,432.40
|
| Rate for Payer: Cash Price |
$3,222.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,013.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,864.80
|
| Rate for Payer: Galaxy Health WC |
$6,087.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,297.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,547.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,225.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,718.88
|
| Rate for Payer: Multiplan Commercial |
$5,729.60
|
| Rate for Payer: Networks By Design Commercial |
$4,655.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,087.70
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH DEEP
|
Facility
|
OP
|
$7,162.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
900501534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: United Healthcare HMO Rider |
$3,581.00
|
| Rate for Payer: Adventist Health Commercial |
$1,432.40
|
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,222.90
|
| Rate for Payer: Cash Price |
$3,222.90
|
| Rate for Payer: Cash Price |
$3,222.90
|
| Rate for Payer: Cigna of CA HMO |
$4,583.68
|
| Rate for Payer: Cigna of CA PPO |
$5,299.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| 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 |
$5,013.40
|
| 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 |
$6,087.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,297.20
|
| 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 |
$4,547.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$551.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,016.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,718.88
|
| 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 |
$5,729.60
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$4,655.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,087.70
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,581.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,581.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,581.00
|
| 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 FB MSCLE/TNDN SHEATH SMPL
|
Facility
|
OP
|
$1,645.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
900501492
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.62 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Galaxy Health WC |
$1,398.25
|
| Rate for Payer: Adventist Health Commercial |
$329.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$740.25
|
| Rate for Payer: Cash Price |
$740.25
|
| Rate for Payer: Cash Price |
$740.25
|
| Rate for Payer: Cigna of CA HMO |
$1,052.80
|
| Rate for Payer: Cigna of CA PPO |
$1,217.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,151.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Global Benefits Group Commercial |
$987.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,044.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$213.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,316.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,069.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,398.25
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$822.50
|
| Rate for Payer: United Healthcare All Other HMO |
$822.50
|
| Rate for Payer: United Healthcare HMO Rider |
$822.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$822.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH SMPL
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
900501492
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.00 |
| Max. Negotiated Rate |
$1,398.25 |
| Rate for Payer: Adventist Health Commercial |
$329.00
|
| Rate for Payer: Cash Price |
$740.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,151.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.00
|
| Rate for Payer: EPIC Health Plan Senior |
$658.00
|
| Rate for Payer: Galaxy Health WC |
$1,398.25
|
| Rate for Payer: Global Benefits Group Commercial |
$987.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,044.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$970.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.80
|
| Rate for Payer: Multiplan Commercial |
$1,316.00
|
| Rate for Payer: Networks By Design Commercial |
$1,069.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,398.25
|
|
|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
|
OP
|
$8,560.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$7,276.00 |
| Rate for Payer: Adventist Health Commercial |
$1,712.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Cigna of CA HMO |
$5,478.40
|
| Rate for Payer: Cigna of CA PPO |
$6,334.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,992.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$7,276.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,136.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,435.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$6,848.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,564.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,276.00
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,280.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,280.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,280.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,280.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
|
IP
|
$8,560.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,712.00 |
| Max. Negotiated Rate |
$7,276.00 |
| Rate for Payer: Adventist Health Commercial |
$1,712.00
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,992.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,424.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,424.00
|
| Rate for Payer: Galaxy Health WC |
$7,276.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,136.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,435.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,050.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.40
|
| Rate for Payer: Multiplan Commercial |
$6,848.00
|
| Rate for Payer: Networks By Design Commercial |
$5,564.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,276.00
|
|
|
HC RMVL FB PHARYNGEAL
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| 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 |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna of CA HMO |
$509.44
|
| Rate for Payer: Cigna of CA PPO |
$589.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| 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 |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$282.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| 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 |
$636.80
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.00
|
| Rate for Payer: United Healthcare All Other HMO |
$398.00
|
| Rate for Payer: United Healthcare HMO Rider |
$398.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PHARYNGEAL
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
|
