|
HC RMVL FOREIGN BODY EYELID
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$630.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| 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 |
$605.18
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,230.40
|
| Rate for Payer: Cigna of CA HMO |
$984.32
|
| Rate for Payer: Cigna of CA PPO |
$1,138.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,384.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,025.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$1,153.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$922.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$922.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC RMVL FOREIGN BODY EYELID
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| 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 |
$605.18
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,230.40
|
| Rate for Payer: Cigna of CA HMO |
$984.32
|
| Rate for Payer: Cigna of CA PPO |
$1,138.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,384.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,025.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$1,153.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$922.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.00
|
| Rate for Payer: United Healthcare All Other HMO |
$769.00
|
| Rate for Payer: United Healthcare HMO Rider |
$769.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC RMVL FOREIGN BODY EYELID
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$1,384.20 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$615.20
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,384.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,025.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$952.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.60
|
| Rate for Payer: Multiplan Commercial |
$1,153.50
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
|
|
HC RMVL FOREIGN BODY EYELID
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$1,384.20 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$615.20
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,384.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,025.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$952.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.60
|
| Rate for Payer: Multiplan Commercial |
$1,153.50
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$485.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$485.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| 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 |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| 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 |
$393.03
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: Cigna of CA HMO |
$502.40
|
| Rate for Payer: Cigna of CA PPO |
$580.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: InnovAge PACE Commercial |
$370.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$246.67
|
| Rate for Payer: Preferred Health Network WC |
$401.05
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
| Rate for Payer: Prime Health Services Medicare |
$261.47
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Riverside University Health System MISP |
$271.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$392.50
|
| Rate for Payer: United Healthcare All Other HMO |
$392.50
|
| Rate for Payer: United Healthcare HMO Rider |
$392.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$392.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$321.85
|
| 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 |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| 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 |
$393.03
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: Cigna of CA HMO |
$502.40
|
| Rate for Payer: Cigna of CA PPO |
$580.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: InnovAge PACE Commercial |
$370.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$246.67
|
| Rate for Payer: Preferred Health Network WC |
$401.05
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
| Rate for Payer: Prime Health Services Medicare |
$261.47
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Riverside University Health System MISP |
$271.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$604.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$866.27
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$120.25
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,180.00
|
| Rate for Payer: Cigna of CA HMO |
$944.00
|
| Rate for Payer: Cigna of CA PPO |
$1,091.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$1,253.75
|
| Rate for Payer: Global Benefits Group Commercial |
$885.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,327.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$1,106.25
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$958.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,253.75
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$885.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$885.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.00 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Adventist Health Commercial |
$295.00
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,180.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.00
|
| Rate for Payer: EPIC Health Plan Senior |
$590.00
|
| Rate for Payer: Galaxy Health WC |
$1,253.75
|
| Rate for Payer: Global Benefits Group Commercial |
$885.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,327.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$913.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.00
|
| Rate for Payer: Multiplan Commercial |
$1,106.25
|
| Rate for Payer: Networks By Design Commercial |
$958.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,253.75
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$295.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| 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 |
$120.25
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,180.00
|
| Rate for Payer: Cigna of CA HMO |
$944.00
|
| Rate for Payer: Cigna of CA PPO |
$1,091.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$1,253.75
|
| Rate for Payer: Global Benefits Group Commercial |
$885.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,327.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$1,106.25
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$958.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,253.75
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$885.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$737.50
|
| Rate for Payer: United Healthcare All Other HMO |
$737.50
|
| Rate for Payer: United Healthcare HMO Rider |
$737.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$737.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$295.00 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Adventist Health Commercial |
$295.00
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,180.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.00
|
| Rate for Payer: EPIC Health Plan Senior |
$590.00
|
| Rate for Payer: Galaxy Health WC |
$1,253.75
|
| Rate for Payer: Global Benefits Group Commercial |
$885.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,327.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$913.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.00
|
| Rate for Payer: Multiplan Commercial |
$1,106.25
|
| Rate for Payer: Networks By Design Commercial |
$958.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,253.75
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
IP
|
$7,383.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,476.60 |
| Max. Negotiated Rate |
$6,644.70 |
| Rate for Payer: Adventist Health Commercial |
$1,476.60
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,953.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,953.20
|
| Rate for Payer: Galaxy Health WC |
$6,275.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,644.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,570.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.60
|
| Rate for Payer: Multiplan Commercial |
$5,537.25
|
| Rate for Payer: Networks By Design Commercial |
$4,798.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,275.55
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
IP
|
$7,383.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,476.60 |
| Max. Negotiated Rate |
$6,644.70 |
| Rate for Payer: Adventist Health Commercial |
$1,476.60
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,953.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,953.20
|
| Rate for Payer: Galaxy Health WC |
$6,275.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,644.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,570.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.60
|
| Rate for Payer: Multiplan Commercial |
$5,537.25
|
| Rate for Payer: Networks By Design Commercial |
$4,798.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,275.55
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
OP
|
$7,383.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$301.51 |
| Max. Negotiated Rate |
$6,644.70 |
| Rate for Payer: Adventist Health Commercial |
$3,027.03
|
| 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 |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| 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 |
$6,436.87
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,906.40
|
| Rate for Payer: Cigna of CA HMO |
$4,725.12
|
| Rate for Payer: Cigna of CA PPO |
$5,463.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,275.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,644.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$5,537.25
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,798.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$6,275.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,429.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,429.80
|
| 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 |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
OP
|
$7,383.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.51 |
| Max. Negotiated Rate |
$6,644.70 |
| Rate for Payer: Adventist Health Commercial |
$1,476.60
|
| 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 |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| 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 |
$6,436.87
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,906.40
|
| Rate for Payer: Cigna of CA HMO |
$4,725.12
|
| Rate for Payer: Cigna of CA PPO |
$5,463.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,275.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,644.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$5,537.25
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,798.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$6,275.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,429.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,691.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,691.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,691.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,691.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
IP
|
$9,197.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906820266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,839.40 |
| Max. Negotiated Rate |
$8,277.30 |
| Rate for Payer: Adventist Health Commercial |
$1,839.40
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,678.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,678.80
|
| Rate for Payer: Galaxy Health WC |
$7,817.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,518.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,277.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,504.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,692.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.40
|
| Rate for Payer: Multiplan Commercial |
$6,897.75
|
| Rate for Payer: Networks By Design Commercial |
$5,978.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,817.45
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
OP
|
$8,737.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$46.11 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$1,747.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,426.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,805.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,552.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,230.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,131.24
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,931.65
|
| Rate for Payer: Cash Price |
$3,931.65
|
| Rate for Payer: Cash Price |
$3,931.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,989.60
|
| Rate for Payer: Cigna of CA HMO |
$5,591.68
|
| Rate for Payer: Cigna of CA PPO |
$6,465.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,426.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,426.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,426.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,494.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,494.80
|
| Rate for Payer: Galaxy Health WC |
$7,426.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,242.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,863.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.11
|
| Rate for Payer: InnovAge PACE Commercial |
$4,368.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,827.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,408.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,747.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,115.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,115.90
|
| Rate for Payer: Multiplan Commercial |
$6,552.75
|
| Rate for Payer: Networks By Design Commercial |
$5,679.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,426.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,494.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,242.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,426.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,426.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,426.45
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
IP
|
$8,737.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,747.40 |
| Max. Negotiated Rate |
$7,863.30 |
| Rate for Payer: Adventist Health Commercial |
$1,747.40
|
| Rate for Payer: Cash Price |
$3,931.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,989.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,494.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,494.80
|
| Rate for Payer: Galaxy Health WC |
$7,426.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,242.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,863.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,827.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,328.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,408.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,747.40
|
| Rate for Payer: Multiplan Commercial |
$6,552.75
|
| Rate for Payer: Networks By Design Commercial |
$5,679.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,426.45
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
OP
|
$9,197.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906820266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$46.11 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$1,839.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,817.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,058.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,897.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,453.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,401.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,357.60
|
| Rate for Payer: Cigna of CA HMO |
$5,886.08
|
| Rate for Payer: Cigna of CA PPO |
$6,805.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,817.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,817.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,817.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,678.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,678.80
|
| Rate for Payer: Galaxy Health WC |
$7,817.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,518.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,277.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.11
|
| Rate for Payer: InnovAge PACE Commercial |
$4,598.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,692.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,437.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,437.90
|
| Rate for Payer: Multiplan Commercial |
$6,897.75
|
| Rate for Payer: Networks By Design Commercial |
$5,978.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,817.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,678.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,518.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,817.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,817.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,817.45
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
IP
|
$1,916.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$383.20 |
| Max. Negotiated Rate |
$1,724.40 |
| Rate for Payer: Adventist Health Commercial |
$383.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.40
|
| Rate for Payer: EPIC Health Plan Senior |
$766.40
|
| Rate for Payer: Galaxy Health WC |
$1,628.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,724.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,186.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.20
|
| Rate for Payer: Multiplan Commercial |
$1,437.00
|
| Rate for Payer: Networks By Design Commercial |
$1,245.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,628.60
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
OP
|
$1,916.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$785.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,163.59
|
| 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 |
$1,125.27
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.80
|
| Rate for Payer: Cigna of CA HMO |
$1,226.24
|
| Rate for Payer: Cigna of CA PPO |
$1,417.84
|
| 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 |
$1,628.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,724.40
|
| 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 |
$1,277.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.20
|
| 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 |
$1,437.00
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$1,245.40
|
| 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 |
$1,628.60
|
| 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 |
$1,149.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.60
|
| 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 |
$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 INTRANASAL FB
|
Facility
|
IP
|
$1,916.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$383.20 |
| Max. Negotiated Rate |
$1,724.40 |
| Rate for Payer: Adventist Health Commercial |
$383.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.40
|
| Rate for Payer: EPIC Health Plan Senior |
$766.40
|
| Rate for Payer: Galaxy Health WC |
$1,628.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,724.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,186.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.20
|
| Rate for Payer: Multiplan Commercial |
$1,437.00
|
| Rate for Payer: Networks By Design Commercial |
$1,245.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,628.60
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
OP
|
$1,916.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$383.20
|
| 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 |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.80
|
| Rate for Payer: Cigna of CA HMO |
$1,226.24
|
| Rate for Payer: Cigna of CA PPO |
$1,417.84
|
| 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 |
$1,628.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,724.40
|
| 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 |
$1,277.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.20
|
| 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 |
$1,437.00
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$1,245.40
|
| 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 |
$1,628.60
|
| 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 |
$1,149.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$958.00
|
| Rate for Payer: United Healthcare All Other HMO |
$958.00
|
| Rate for Payer: United Healthcare HMO Rider |
$958.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$958.00
|
| 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 INTRANASAL LESION
|
Facility
|
IP
|
$7,633.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,526.60 |
| Max. Negotiated Rate |
$6,869.70 |
| Rate for Payer: Adventist Health Commercial |
$1,526.60
|
| Rate for Payer: Cash Price |
$3,434.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,053.20
|
| Rate for Payer: Galaxy Health WC |
$6,488.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,579.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,869.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,091.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,908.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,724.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,526.60
|
| Rate for Payer: Multiplan Commercial |
$5,724.75
|
| Rate for Payer: Networks By Design Commercial |
$4,961.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,488.05
|
|
