|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,489.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,422.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,310.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,489.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,422.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,310.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947200113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,489.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,422.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,310.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$2,484.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.80 |
| Max. Negotiated Rate |
$2,235.60 |
| Rate for Payer: Adventist Health Commercial |
$496.80
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$993.60
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,537.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$496.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO |
$1,589.76
|
| Rate for Payer: Cigna of CA PPO |
$1,838.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$785.56
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
| Rate for Payer: Prime Health Services Medicare |
$832.69
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,489.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,422.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,310.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947300113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Cigna of CA HMO |
$2,389.12
|
| Rate for Payer: Cigna of CA PPO |
$2,762.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,489.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$785.56
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
| Rate for Payer: Prime Health Services Medicare |
$832.69
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,239.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947300113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,489.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,422.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,310.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.87 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$786.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,144.00
|
| Rate for Payer: Cigna of CA HMO |
$2,515.20
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,537.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$2,947.50
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$786.00 |
| Max. Negotiated Rate |
$3,537.00 |
| Rate for Payer: Adventist Health Commercial |
$786.00
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,537.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,432.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.00
|
| Rate for Payer: Multiplan Commercial |
$2,947.50
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
IP
|
$10,146.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,029.20 |
| Max. Negotiated Rate |
$9,131.40 |
| Rate for Payer: Adventist Health Commercial |
$2,029.20
|
| Rate for Payer: Cash Price |
$5,580.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,116.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,058.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,058.40
|
| Rate for Payer: Galaxy Health WC |
$8,624.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,087.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,131.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,767.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,865.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,280.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,029.20
|
| Rate for Payer: Multiplan Commercial |
$7,609.50
|
| Rate for Payer: Networks By Design Commercial |
$6,594.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,624.10
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
OP
|
$10,146.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.37 |
| Max. Negotiated Rate |
$9,131.40 |
| Rate for Payer: Adventist Health Commercial |
$2,029.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,187.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,270.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,791.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,634.30
|
| Rate for Payer: Cash Price |
$5,580.30
|
| Rate for Payer: Cash Price |
$5,580.30
|
| Rate for Payer: Cash Price |
$5,580.30
|
| Rate for Payer: Cash Price |
$5,580.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,116.80
|
| Rate for Payer: Cigna of CA HMO |
$6,493.44
|
| Rate for Payer: Cigna of CA PPO |
$7,508.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,187.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,270.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,791.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,468.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,791.43
|
| Rate for Payer: Galaxy Health WC |
$8,624.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,087.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,131.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,857.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,791.43
|
| Rate for Payer: InnovAge PACE Commercial |
$7,187.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,767.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,791.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,029.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,420.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,420.52
|
| Rate for Payer: Multiplan Commercial |
$7,609.50
|
| Rate for Payer: Multiplan WC |
$7,634.30
|
| Rate for Payer: Networks By Design Commercial |
$6,594.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,791.43
|
| Rate for Payer: Preferred Health Network WC |
$7,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$8,624.10
|
| Rate for Payer: Prime Health Services Medicare |
$5,078.92
|
| Rate for Payer: Prime Health Services WC |
$7,556.40
|
| Rate for Payer: Riverside University Health System MISP |
$5,270.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,087.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,073.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,073.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,073.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,073.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,791.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,187.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,270.57
|
| Rate for Payer: Vantage Medical Group Senior |
$4,791.43
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
OP
|
$6,405.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$1,281.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Cash Price |
$3,522.75
|
| Rate for Payer: Cash Price |
$3,522.75
|
| Rate for Payer: Cash Price |
$3,522.75
|
| Rate for Payer: Cash Price |
$3,522.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,124.00
|
| Rate for Payer: Cigna of CA HMO |
$4,099.20
|
| Rate for Payer: Cigna of CA PPO |
$4,739.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,444.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,843.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,764.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,158.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,803.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,163.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,444.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,843.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,202.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,202.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,202.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,202.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
IP
|
$6,405.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,281.00 |
| Max. Negotiated Rate |
$5,764.50 |
| Rate for Payer: Adventist Health Commercial |
$1,281.00
|
| Rate for Payer: Cash Price |
$3,522.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,124.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,562.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,562.00
|
| Rate for Payer: Galaxy Health WC |
$5,444.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,843.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,764.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,440.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,964.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$4,803.75
|
| Rate for Payer: Networks By Design Commercial |
$4,163.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,444.25
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,012.60 |
| Max. Negotiated Rate |
$4,556.70 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,025.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.20
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,377.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,929.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,134.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: Cigna of CA HMO |
$3,240.32
|
| Rate for Payer: Cigna of CA PPO |
$3,746.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,377.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,980.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,037.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,531.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,531.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,531.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,531.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.22 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: Cigna of CA HMO |
$3,240.32
|
| Rate for Payer: Cigna of CA PPO |
$3,746.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,377.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,037.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,531.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,531.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,531.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,531.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,012.60 |
| Max. Negotiated Rate |
$4,556.70 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,025.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.20
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,377.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,929.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,134.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
IP
|
$2,163.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$1,946.70 |
| Rate for Payer: Adventist Health Commercial |
$432.60
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,730.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$865.20
|
| Rate for Payer: EPIC Health Plan Senior |
$865.20
|
| Rate for Payer: Galaxy Health WC |
$1,838.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,946.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$824.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,338.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.60
|
| Rate for Payer: Multiplan Commercial |
$1,622.25
|
| Rate for Payer: Networks By Design Commercial |
$1,405.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,838.55
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
OP
|
$2,163.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$432.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,730.40
|
| Rate for Payer: Cigna of CA HMO |
$1,384.32
|
| Rate for Payer: Cigna of CA PPO |
$1,600.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,838.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,946.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,622.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,405.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,838.55
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,081.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,081.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,081.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
OP
|
$2,163.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$886.83
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,730.40
|
| Rate for Payer: Cigna of CA HMO |
$1,384.32
|
| Rate for Payer: Cigna of CA PPO |
$1,600.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,838.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,946.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,622.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,405.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,838.55
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.80
|
| 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 |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
IP
|
$2,163.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$1,946.70 |
| Rate for Payer: Adventist Health Commercial |
$432.60
|
| Rate for Payer: Cash Price |
$1,189.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,730.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$865.20
|
| Rate for Payer: EPIC Health Plan Senior |
$865.20
|
| Rate for Payer: Galaxy Health WC |
$1,838.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,946.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$824.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,338.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.60
|
| Rate for Payer: Multiplan Commercial |
$1,622.25
|
| Rate for Payer: Networks By Design Commercial |
$1,405.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,838.55
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$2,007.90 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Cash Price |
$1,227.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,007.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,380.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Multiplan Commercial |
$1,673.25
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.46 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,227.05
|
| Rate for Payer: Cash Price |
$1,227.05
|
| Rate for Payer: Cash Price |
$1,227.05
|
| Rate for Payer: Cash Price |
$1,227.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| Rate for Payer: Cigna of CA HMO |
$1,427.84
|
| Rate for Payer: Cigna of CA PPO |
$1,650.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,007.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,673.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,338.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$2,007.90 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Cash Price |
$1,227.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,007.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,380.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Multiplan Commercial |
$1,673.25
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
|
