|
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 |
$1,167.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,698.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,416.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,314.14
|
| 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 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 |
$2,696.00 |
| 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 |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| 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 |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| 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 |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,212.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| 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 |
$507.02
|
| 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 |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| 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 |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
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 |
$999.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,454.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,212.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$692.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,125.34
|
| 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
|
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 |
$999.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,454.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,212.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$692.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,125.34
|
| 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 |
$273.75 |
| Max. Negotiated Rate |
$1,833.00 |
| 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 |
$1,104.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,067.71
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| 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 |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| 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 |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,212.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| 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 |
$507.02
|
| 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 |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| 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 |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
OP
|
$1,438.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$589.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$873.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$844.54
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$790.90
|
| Rate for Payer: Cash Price |
$790.90
|
| Rate for Payer: Cash Price |
$790.90
|
| Rate for Payer: Cash Price |
$790.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,150.40
|
| Rate for Payer: Cigna of CA HMO |
$920.32
|
| Rate for Payer: Cigna of CA PPO |
$1,064.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$959.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$1,078.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$934.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$1,222.30
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$862.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$862.80
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
IP
|
$1,438.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.60 |
| Max. Negotiated Rate |
$1,294.20 |
| Rate for Payer: Adventist Health Commercial |
$287.60
|
| Rate for Payer: Cash Price |
$790.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,150.40
|
| 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 Permanente of CA Commercial/Self Funded |
$959.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$890.12
|
| 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
|
|
|
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 |
$790.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,150.40
|
| 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 Permanente of CA Commercial/Self Funded |
$959.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$890.12
|
| 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
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
OP
|
$1,438.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$287.60
|
| 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 |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$790.90
|
| Rate for Payer: Cash Price |
$790.90
|
| Rate for Payer: Cash Price |
$790.90
|
| Rate for Payer: Cash Price |
$790.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,150.40
|
| Rate for Payer: Cigna of CA HMO |
$920.32
|
| Rate for Payer: Cigna of CA PPO |
$1,064.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$959.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$1,078.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$934.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$1,222.30
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$862.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$719.00
|
| Rate for Payer: United Healthcare All Other HMO |
$719.00
|
| Rate for Payer: United Healthcare HMO Rider |
$719.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$719.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
OP
|
$10,401.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,238.00 |
| Rate for Payer: Adventist Health Commercial |
$2,080.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,794.14
|
| Rate for Payer: Cash Price |
$5,720.55
|
| Rate for Payer: Cash Price |
$5,720.55
|
| Rate for Payer: Cash Price |
$5,720.55
|
| Rate for Payer: Cash Price |
$5,720.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,320.80
|
| Rate for Payer: Cigna of CA HMO |
$6,656.64
|
| Rate for Payer: Cigna of CA PPO |
$7,696.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$8,840.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,360.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: InnovAge PACE Commercial |
$5,454.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,937.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,080.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,872.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$7,800.75
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$6,760.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Preferred Health Network WC |
$5,912.39
|
| Rate for Payer: Prime Health Services Commercial |
$8,840.85
|
| Rate for Payer: Prime Health Services Medicare |
$3,854.71
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Riverside University Health System MISP |
$4,000.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,200.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,200.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,200.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,200.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
IP
|
$10,401.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,080.20 |
| Max. Negotiated Rate |
$9,360.90 |
| Rate for Payer: Adventist Health Commercial |
$2,080.20
|
| Rate for Payer: Cash Price |
$5,720.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,320.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,160.40
|
| Rate for Payer: Galaxy Health WC |
$8,840.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,360.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,937.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,962.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,438.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,080.20
|
| Rate for Payer: Multiplan Commercial |
$7,800.75
|
| Rate for Payer: Networks By Design Commercial |
$6,760.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,840.85
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.88 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| 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 |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Central Health Plan Commercial |
$885.60
|
| Rate for Payer: Cigna of CA HMO |
$708.48
|
| Rate for Payer: Cigna of CA PPO |
$819.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$664.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$553.50
|
| Rate for Payer: United Healthcare All Other HMO |
$553.50
|
| Rate for Payer: United Healthcare HMO Rider |
$553.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$996.30 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Central Health Plan Commercial |
$885.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: EPIC Health Plan Senior |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$685.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$996.30 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Central Health Plan Commercial |
$885.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: EPIC Health Plan Senior |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$685.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$140.88 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$453.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$672.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.14
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Central Health Plan Commercial |
$885.60
|
| Rate for Payer: Cigna of CA HMO |
$708.48
|
| Rate for Payer: Cigna of CA PPO |
$819.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$664.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
IP
|
$4,277.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$855.40 |
| Max. Negotiated Rate |
$3,849.30 |
| Rate for Payer: Adventist Health Commercial |
$855.40
|
| Rate for Payer: Cash Price |
$2,352.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,421.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,710.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,710.80
|
| Rate for Payer: Galaxy Health WC |
$3,635.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,566.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,849.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,852.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,629.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,647.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.40
|
| Rate for Payer: Multiplan Commercial |
$3,207.75
|
| Rate for Payer: Networks By Design Commercial |
$2,780.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,635.45
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
OP
|
$4,277.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$855.40
|
| 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 |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$3,280.13
|
| Rate for Payer: Cash Price |
$2,352.35
|
| Rate for Payer: Cash Price |
$2,352.35
|
| Rate for Payer: Cash Price |
$2,352.35
|
| Rate for Payer: Cash Price |
$2,352.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,421.60
|
| Rate for Payer: Cigna of CA HMO |
$2,737.28
|
| Rate for Payer: Cigna of CA PPO |
$3,164.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,635.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,566.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,849.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,852.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$3,207.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,780.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,635.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,566.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,138.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,138.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,138.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,138.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
IP
|
$10,508.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,101.60 |
| Max. Negotiated Rate |
$9,457.20 |
| Rate for Payer: Adventist Health Commercial |
$2,101.60
|
| Rate for Payer: Cash Price |
$5,779.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,203.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,203.20
|
| Rate for Payer: Galaxy Health WC |
$8,931.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,304.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,457.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,008.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,003.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,504.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,101.60
|
| Rate for Payer: Multiplan Commercial |
$7,881.00
|
| Rate for Payer: Networks By Design Commercial |
$6,830.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,931.80
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
OP
|
$10,508.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,457.20 |
| Rate for Payer: Adventist Health Commercial |
$2,101.60
|
| 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 |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$3,280.13
|
| Rate for Payer: Cash Price |
$5,779.40
|
| Rate for Payer: Cash Price |
$5,779.40
|
| Rate for Payer: Cash Price |
$5,779.40
|
| Rate for Payer: Cash Price |
$5,779.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,406.40
|
| Rate for Payer: Cigna of CA HMO |
$6,725.12
|
| Rate for Payer: Cigna of CA PPO |
$7,775.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$8,931.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,304.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,457.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,008.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,101.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$7,881.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$6,830.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$8,931.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,304.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,254.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,254.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,254.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,254.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$3,256.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$1,334.96
|
| 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 |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,604.80
|
| Rate for Payer: Cigna of CA HMO |
$2,083.84
|
| Rate for Payer: Cigna of CA PPO |
$2,409.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,767.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,953.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,930.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,171.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,442.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,116.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,767.60
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,953.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,953.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$3,256.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$651.20
|
| 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 |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,604.80
|
| Rate for Payer: Cigna of CA HMO |
$2,083.84
|
| Rate for Payer: Cigna of CA PPO |
$2,409.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,767.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,953.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,930.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,171.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,442.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,116.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,767.60
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,953.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,628.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,628.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,628.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,628.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$3,256.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$651.20 |
| Max. Negotiated Rate |
$2,930.40 |
| Rate for Payer: Adventist Health Commercial |
$651.20
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,302.40
|
| Rate for Payer: Galaxy Health WC |
$2,767.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,953.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,930.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,171.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,240.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,015.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.20
|
| Rate for Payer: Multiplan Commercial |
$2,442.00
|
| Rate for Payer: Networks By Design Commercial |
$2,116.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,767.60
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$3,256.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$651.20 |
| Max. Negotiated Rate |
$2,930.40 |
| Rate for Payer: Adventist Health Commercial |
$651.20
|
| Rate for Payer: Cash Price |
$1,790.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,302.40
|
| Rate for Payer: Galaxy Health WC |
$2,767.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,953.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,930.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,171.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,240.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,015.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.20
|
| Rate for Payer: Multiplan Commercial |
$2,442.00
|
| Rate for Payer: Networks By Design Commercial |
$2,116.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,767.60
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
OP
|
$6,445.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,289.00
|
| 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 |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| 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 |
$4,617.28
|
| Rate for Payer: Cash Price |
$3,544.75
|
| Rate for Payer: Cash Price |
$3,544.75
|
| Rate for Payer: Cash Price |
$3,544.75
|
| Rate for Payer: Cash Price |
$3,544.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,156.00
|
| Rate for Payer: Cigna of CA HMO |
$4,124.80
|
| Rate for Payer: Cigna of CA PPO |
$4,769.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$5,478.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,867.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,800.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: InnovAge PACE Commercial |
$4,346.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,298.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,289.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,883.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,833.75
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$4,189.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$5,478.25
|
| Rate for Payer: Prime Health Services Medicare |
$3,071.77
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,187.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,867.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,222.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,222.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,222.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
IP
|
$6,445.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,289.00 |
| Max. Negotiated Rate |
$5,800.50 |
| Rate for Payer: Adventist Health Commercial |
$1,289.00
|
| Rate for Payer: Cash Price |
$3,544.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,578.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,578.00
|
| Rate for Payer: Galaxy Health WC |
$5,478.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,867.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,800.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,298.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,455.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,989.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,289.00
|
| Rate for Payer: Multiplan Commercial |
$4,833.75
|
| Rate for Payer: Networks By Design Commercial |
$4,189.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,478.25
|
|
