|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
OP
|
$6,094.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
901200090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$287.52 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,218.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,742.30
|
| Rate for Payer: Cash Price |
$2,742.30
|
| Rate for Payer: Cash Price |
$2,742.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,875.20
|
| Rate for Payer: Cigna of CA HMO |
$3,900.16
|
| Rate for Payer: Cigna of CA PPO |
$4,509.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,265.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$5,179.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,484.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$287.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,869.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,570.50
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,961.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$5,179.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,146.11
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,227.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
IP
|
$6,094.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
901200090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,218.80 |
| Max. Negotiated Rate |
$5,484.60 |
| Rate for Payer: Adventist Health Commercial |
$1,218.80
|
| Rate for Payer: Cash Price |
$2,742.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,875.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,265.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,437.60
|
| Rate for Payer: Galaxy Health WC |
$5,179.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,484.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,869.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,595.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.80
|
| Rate for Payer: Multiplan Commercial |
$4,570.50
|
| Rate for Payer: Networks By Design Commercial |
$3,961.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,179.90
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
IP
|
$6,094.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,218.80 |
| Max. Negotiated Rate |
$5,484.60 |
| Rate for Payer: Adventist Health Commercial |
$1,218.80
|
| Rate for Payer: Cash Price |
$2,742.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,875.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,265.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,437.60
|
| Rate for Payer: Galaxy Health WC |
$5,179.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,484.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,869.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,595.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.80
|
| Rate for Payer: Multiplan Commercial |
$4,570.50
|
| Rate for Payer: Networks By Design Commercial |
$3,961.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,179.90
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
OP
|
$6,094.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$287.52 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,218.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,742.30
|
| Rate for Payer: Cash Price |
$2,742.30
|
| Rate for Payer: Cash Price |
$2,742.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,875.20
|
| Rate for Payer: Cigna of CA HMO |
$3,900.16
|
| Rate for Payer: Cigna of CA PPO |
$4,509.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,265.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$5,179.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,484.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$287.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,869.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,570.50
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,961.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$5,179.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,146.11
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,227.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$120.25
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Central Health Plan Commercial |
$332.00
|
| Rate for Payer: Cigna of CA HMO |
$265.60
|
| Rate for Payer: Cigna of CA PPO |
$307.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.50
|
| Rate for Payer: United Healthcare All Other HMO |
$207.50
|
| Rate for Payer: United Healthcare HMO Rider |
$207.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$373.50 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Central Health Plan Commercial |
$332.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$244.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$170.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.41
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$120.25
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Central Health Plan Commercial |
$332.00
|
| Rate for Payer: Cigna of CA HMO |
$265.60
|
| Rate for Payer: Cigna of CA PPO |
$307.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$373.50 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Central Health Plan Commercial |
$332.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$244.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$864.00
|
| Rate for Payer: Cigna of CA PPO |
$999.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO |
$675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$675.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$553.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$783.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$864.00
|
| Rate for Payer: Cigna of CA PPO |
$999.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$1,384.20 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,230.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,076.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$615.20
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,384.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$976.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$907.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.60
|
| Rate for Payer: Multiplan Commercial |
$1,153.50
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$630.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.48
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,230.40
|
| Rate for Payer: Cigna of CA HMO |
$984.32
|
| Rate for Payer: Cigna of CA PPO |
$1,138.12
|
| 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 |
$1,076.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,384.20
|
| 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 |
$976.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,153.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$922.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$922.80
|
| 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 CONJUNCTIVA
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$1,384.20 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,230.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,076.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$615.20
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,384.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$976.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$907.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.60
|
| Rate for Payer: Multiplan Commercial |
$1,153.50
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,230.40
|
| Rate for Payer: Cigna of CA HMO |
$984.32
|
| Rate for Payer: Cigna of CA PPO |
$1,138.12
|
| 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 |
$1,076.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,384.20
|
| 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 |
$976.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,153.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$922.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.00
|
| Rate for Payer: United Healthcare All Other HMO |
$769.00
|
| Rate for Payer: United Healthcare HMO Rider |
$769.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
OP
|
$2,123.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$870.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$281.51
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,698.40
|
| Rate for Payer: Cigna of CA HMO |
$1,358.72
|
| Rate for Payer: Cigna of CA PPO |
$1,571.02
|
| 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 |
$1,486.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,804.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,273.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,910.70
|
| 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 |
$1,348.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,592.25
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$1,379.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,804.55
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,273.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,273.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
IP
|
$2,123.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$424.60 |
| Max. Negotiated Rate |
$1,910.70 |
| Rate for Payer: Adventist Health Commercial |
$424.60
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,698.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,486.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$849.20
|
| Rate for Payer: Galaxy Health WC |
$1,804.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,273.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,910.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,348.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,252.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.60
|
| Rate for Payer: Multiplan Commercial |
$1,592.25
|
| Rate for Payer: Networks By Design Commercial |
$1,379.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,804.55
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
IP
|
$2,123.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.60 |
| Max. Negotiated Rate |
$1,910.70 |
| Rate for Payer: Adventist Health Commercial |
$424.60
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,698.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,486.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$849.20
|
| Rate for Payer: Galaxy Health WC |
$1,804.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,273.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,910.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,348.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,252.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.60
|
| Rate for Payer: Multiplan Commercial |
$1,592.25
|
| Rate for Payer: Networks By Design Commercial |
$1,379.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,804.55
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
OP
|
$2,123.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$424.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Cash Price |
$955.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,698.40
|
| Rate for Payer: Cigna of CA HMO |
$1,358.72
|
| Rate for Payer: Cigna of CA PPO |
$1,571.02
|
| 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 |
$1,486.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,804.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,273.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,910.70
|
| 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 |
$1,348.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,592.25
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$1,379.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,804.55
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,273.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,061.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,061.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,061.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
IP
|
$1,818.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.60 |
| Max. Negotiated Rate |
$1,636.20 |
| Rate for Payer: Adventist Health Commercial |
$363.60
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,454.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,272.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$727.20
|
| Rate for Payer: EPIC Health Plan Senior |
$727.20
|
| Rate for Payer: Galaxy Health WC |
$1,545.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,090.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,636.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,154.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| Rate for Payer: Multiplan Commercial |
$1,363.50
|
| Rate for Payer: Networks By Design Commercial |
$1,181.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,545.30
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
IP
|
$1,818.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$363.60 |
| Max. Negotiated Rate |
$1,636.20 |
| Rate for Payer: Adventist Health Commercial |
$363.60
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,454.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,272.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$727.20
|
| Rate for Payer: EPIC Health Plan Senior |
$727.20
|
| Rate for Payer: Galaxy Health WC |
$1,545.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,090.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,636.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,154.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| Rate for Payer: Multiplan Commercial |
$1,363.50
|
| Rate for Payer: Networks By Design Commercial |
$1,181.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,545.30
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
OP
|
$1,818.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$220.39 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$745.38
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.39
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,454.40
|
| Rate for Payer: Cigna of CA HMO |
$1,163.52
|
| Rate for Payer: Cigna of CA PPO |
$1,345.32
|
| 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 |
$1,272.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,545.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,090.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,636.20
|
| 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 |
$1,154.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,363.50
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$1,181.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,545.30
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,090.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,090.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
OP
|
$1,818.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$363.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Cash Price |
$818.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,454.40
|
| Rate for Payer: Cigna of CA HMO |
$1,163.52
|
| Rate for Payer: Cigna of CA PPO |
$1,345.32
|
| 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 |
$1,272.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,545.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,090.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,636.20
|
| 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 |
$1,154.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,363.50
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$1,181.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,545.30
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,090.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$909.00
|
| Rate for Payer: United Healthcare All Other HMO |
$909.00
|
| Rate for Payer: United Healthcare HMO Rider |
$909.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$909.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
IP
|
$1,438.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$287.60 |
| Max. Negotiated Rate |
$1,294.20 |
| Rate for Payer: Adventist Health Commercial |
$287.60
|
| Rate for Payer: Cash Price |
$647.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,150.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,006.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$575.20
|
| Rate for Payer: Galaxy Health WC |
$1,222.30
|
| Rate for Payer: Global Benefits Group Commercial |
$862.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,294.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$913.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$848.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.60
|
| Rate for Payer: Multiplan Commercial |
$1,078.50
|
| Rate for Payer: Networks By Design Commercial |
$934.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,222.30
|
|
