|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
IP
|
$3,724.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$3,165.40 |
| Rate for Payer: Adventist Health Commercial |
$744.80
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,606.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,489.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,489.60
|
| Rate for Payer: Galaxy Health WC |
$3,165.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,234.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,364.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,197.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$893.76
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: Networks By Design Commercial |
$2,420.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,165.40
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
OP
|
$3,724.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.51 |
| Max. Negotiated Rate |
$6,869.74 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
| Rate for Payer: Adventist Health Commercial |
$744.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna of CA HMO |
$2,383.36
|
| Rate for Payer: Cigna of CA PPO |
$2,755.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,606.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$3,165.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,234.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,364.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$893.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$2,420.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,165.40
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,234.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,862.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,862.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,862.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,862.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
OP
|
$3,724.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$301.51 |
| Max. Negotiated Rate |
$6,869.74 |
| Rate for Payer: Adventist Health Commercial |
$1,526.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,130.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna of CA HMO |
$2,383.36
|
| Rate for Payer: Cigna of CA PPO |
$2,755.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,606.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$3,165.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,234.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,364.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$893.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$2,420.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,165.40
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,234.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,234.40
|
| 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 |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
OP
|
$8,990.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$1,798.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,641.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,944.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,742.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$4,045.50
|
| Rate for Payer: Cash Price |
$4,045.50
|
| Rate for Payer: Cash Price |
$4,045.50
|
| Rate for Payer: Cigna of CA HMO |
$5,753.60
|
| Rate for Payer: Cigna of CA PPO |
$6,652.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,641.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,641.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,641.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,293.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,596.00
|
| Rate for Payer: Galaxy Health WC |
$7,641.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,708.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,304.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,293.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,293.00
|
| Rate for Payer: Multiplan Commercial |
$7,192.00
|
| Rate for Payer: Networks By Design Commercial |
$5,843.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,641.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,394.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,495.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,641.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,641.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,641.50
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
IP
|
$8,990.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,798.00 |
| Max. Negotiated Rate |
$7,641.50 |
| Rate for Payer: Adventist Health Commercial |
$1,798.00
|
| Rate for Payer: Cash Price |
$4,045.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,293.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,596.00
|
| Rate for Payer: Galaxy Health WC |
$7,641.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,708.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,304.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,157.60
|
| Rate for Payer: Multiplan Commercial |
$7,192.00
|
| Rate for Payer: Networks By Design Commercial |
$5,843.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,641.50
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$505.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$815.91
|
| 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 |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna of CA HMO |
$788.48
|
| Rate for Payer: Cigna of CA PPO |
$911.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| 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 |
$782.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| 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 |
$985.60
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.20
|
| 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 INTRANASAL FB
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$1,047.20 |
| Rate for Payer: Adventist Health Commercial |
$246.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$492.80
|
| Rate for Payer: Galaxy Health WC |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$782.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$726.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| Rate for Payer: Multiplan Commercial |
$985.60
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$1,047.20 |
| Rate for Payer: Adventist Health Commercial |
$246.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$492.80
|
| Rate for Payer: Galaxy Health WC |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$782.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$726.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| Rate for Payer: Multiplan Commercial |
$985.60
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$246.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna of CA HMO |
$788.48
|
| Rate for Payer: Cigna of CA PPO |
$911.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| 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 |
$782.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| 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 |
$985.60
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.00
|
| Rate for Payer: United Healthcare All Other HMO |
$616.00
|
| Rate for Payer: United Healthcare HMO Rider |
$616.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 INTRANASAL FB
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$1,047.20 |
| Rate for Payer: Adventist Health Commercial |
$246.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$492.80
|
| Rate for Payer: Galaxy Health WC |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$782.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$726.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| Rate for Payer: Multiplan Commercial |
$985.60
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$246.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$815.91
|
| 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 |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna of CA HMO |
$788.48
|
| Rate for Payer: Cigna of CA PPO |
$911.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$782.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| 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 |
$985.60
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.00
|
| Rate for Payer: United Healthcare All Other HMO |
$616.00
|
| Rate for Payer: United Healthcare HMO Rider |
$616.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 INTRANASAL LESION
|
Facility
|
IP
|
$5,641.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,128.20 |
| Max. Negotiated Rate |
$4,794.85 |
| Rate for Payer: Adventist Health Commercial |
$1,128.20
|
| Rate for Payer: Cash Price |
$2,538.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,948.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,256.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,256.40
|
| Rate for Payer: Galaxy Health WC |
$4,794.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,384.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,582.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,328.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,353.84
|
| Rate for Payer: Multiplan Commercial |
$4,512.80
|
| Rate for Payer: Networks By Design Commercial |
$3,666.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,794.85
|
|
|
HC RMVL INTRANASAL LESION
|
Facility
|
OP
|
$5,641.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$431.49 |
| Max. Negotiated Rate |
$7,035.98 |
| Rate for Payer: Adventist Health Commercial |
$1,128.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,538.45
|
| Rate for Payer: Cash Price |
$2,538.45
|
| Rate for Payer: Cash Price |
$2,538.45
|
| Rate for Payer: Cigna of CA HMO |
$3,610.24
|
| Rate for Payer: Cigna of CA PPO |
$4,174.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,948.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$4,794.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,384.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,582.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$431.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,353.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$4,512.80
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,666.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,794.85
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,384.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,820.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,820.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,820.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,820.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
OP
|
$5,987.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$7,035.98 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
| Rate for Payer: Adventist Health Commercial |
$1,197.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cigna of CA HMO |
$3,831.68
|
| Rate for Payer: Cigna of CA PPO |
$4,430.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,190.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,801.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$4,789.60
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,891.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,088.95
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,592.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,993.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,993.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,993.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,993.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
IP
|
$5,987.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,197.40 |
| Max. Negotiated Rate |
$5,088.95 |
| Rate for Payer: Adventist Health Commercial |
$1,197.40
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,190.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,394.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,394.80
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,801.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,532.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Multiplan Commercial |
$4,789.60
|
| Rate for Payer: Networks By Design Commercial |
$3,891.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,088.95
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
IP
|
$2,822.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$2,398.70 |
| Rate for Payer: Adventist Health Commercial |
$564.40
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,975.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,128.80
|
| Rate for Payer: Galaxy Health WC |
$2,398.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,693.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,791.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,664.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.28
|
| Rate for Payer: Multiplan Commercial |
$2,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,834.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,398.70
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
IP
|
$2,822.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$2,398.70 |
| Rate for Payer: Adventist Health Commercial |
$564.40
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,975.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,128.80
|
| Rate for Payer: Galaxy Health WC |
$2,398.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,693.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,791.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,664.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.28
|
| Rate for Payer: Multiplan Commercial |
$2,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,834.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,398.70
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
OP
|
$2,822.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$564.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cigna of CA HMO |
$1,806.08
|
| Rate for Payer: Cigna of CA PPO |
$2,088.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,975.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,115.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1,410.37
|
| Rate for Payer: Galaxy Health WC |
$2,398.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,693.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,102.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,791.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,378.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,615.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,718.08
|
| Rate for Payer: Multiplan Commercial |
$2,257.60
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$1,834.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,398.70
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,693.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,411.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,411.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,282.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
OP
|
$2,822.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,157.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$424.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cash Price |
$1,269.90
|
| Rate for Payer: Cigna of CA HMO |
$1,806.08
|
| Rate for Payer: Cigna of CA PPO |
$2,088.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,975.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,115.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1,410.37
|
| Rate for Payer: Galaxy Health WC |
$2,398.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,693.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,102.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,791.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,378.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,615.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,718.08
|
| Rate for Payer: Multiplan Commercial |
$2,257.60
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$1,834.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,398.70
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,693.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,693.20
|
| 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 |
$1,282.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
HC RMVL OF IMPLANT,SUPERFICIAL
|
Facility
|
IP
|
$4,927.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$985.40 |
| Max. Negotiated Rate |
$4,187.95 |
| Rate for Payer: Adventist Health Commercial |
$985.40
|
| Rate for Payer: Cash Price |
$2,217.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,448.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,970.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,970.80
|
| Rate for Payer: Galaxy Health WC |
$4,187.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,956.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,128.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,906.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.48
|
| Rate for Payer: Multiplan Commercial |
$3,941.60
|
| Rate for Payer: Networks By Design Commercial |
$3,202.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,187.95
|
|
|
HC RMVL OF IMPLANT,SUPERFICIAL
|
Facility
|
OP
|
$4,927.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$985.40
|
| 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 |
$2,217.15
|
| Rate for Payer: Cash Price |
$2,217.15
|
| Rate for Payer: Cash Price |
$2,217.15
|
| Rate for Payer: Cigna of CA HMO |
$3,153.28
|
| Rate for Payer: Cigna of CA PPO |
$3,645.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| 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 |
$3,448.90
|
| 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 |
$4,187.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,956.20
|
| 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 |
$3,128.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.48
|
| 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 |
$3,941.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,202.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,187.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,956.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,463.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,463.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,463.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,463.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| 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 OF IMPL FROM HAND
|
Facility
|
OP
|
$9,327.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
900501699
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.94 |
| Max. Negotiated Rate |
$7,927.95 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
| Rate for Payer: Adventist Health Commercial |
$1,865.40
|
| 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 |
$4,197.15
|
| Rate for Payer: Cash Price |
$4,197.15
|
| Rate for Payer: Cash Price |
$4,197.15
|
| Rate for Payer: Cigna of CA HMO |
$5,969.28
|
| Rate for Payer: Cigna of CA PPO |
$6,901.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| 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 |
$6,528.90
|
| 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 |
$7,927.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,596.20
|
| 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 |
$5,922.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.48
|
| 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 |
$7,461.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$6,062.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,927.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,596.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,663.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,663.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,663.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,663.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
|
|
HC RMVL OF IMPL FROM HAND
|
Facility
|
IP
|
$9,327.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
900501699
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,865.40 |
| Max. Negotiated Rate |
$7,927.95 |
| Rate for Payer: Adventist Health Commercial |
$1,865.40
|
| Rate for Payer: Cash Price |
$4,197.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,528.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,730.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,730.80
|
| Rate for Payer: Galaxy Health WC |
$7,927.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,596.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,922.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,502.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.48
|
| Rate for Payer: Multiplan Commercial |
$7,461.60
|
| Rate for Payer: Networks By Design Commercial |
$6,062.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,927.95
|
|
|
HC RMVL OF SKIN TAGS 1-15 LESIONS
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$187.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cigna of CA HMO |
$292.48
|
| Rate for Payer: Cigna of CA PPO |
$338.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.20
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC RMVL OF SKIN TAGS 1-15 LESIONS
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cigna of CA HMO |
$292.48
|
| Rate for Payer: Cigna of CA PPO |
$338.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.50
|
| Rate for Payer: United Healthcare All Other HMO |
$228.50
|
| Rate for Payer: United Healthcare HMO Rider |
$228.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
|
