|
HC RMVL INTRANASAL LESION
|
Facility
|
OP
|
$7,633.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$1,526.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$3,434.85
|
| Rate for Payer: Cash Price |
$3,434.85
|
| Rate for Payer: Cash Price |
$3,434.85
|
| Rate for Payer: Cash Price |
$3,434.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,106.40
|
| Rate for Payer: Cigna of CA HMO |
$4,885.12
|
| Rate for Payer: Cigna of CA PPO |
$5,648.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| 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: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,091.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,526.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$5,724.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$4,961.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,488.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,579.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,816.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,816.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,816.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,816.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
IP
|
$8,101.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,620.20 |
| Max. Negotiated Rate |
$7,290.90 |
| Rate for Payer: Adventist Health Commercial |
$1,620.20
|
| Rate for Payer: Cash Price |
$3,645.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,480.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,240.40
|
| Rate for Payer: Galaxy Health WC |
$6,885.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,860.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,290.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,086.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,014.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.20
|
| Rate for Payer: Multiplan Commercial |
$6,075.75
|
| Rate for Payer: Networks By Design Commercial |
$5,265.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,885.85
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
OP
|
$8,101.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$7,290.90 |
| Rate for Payer: Adventist Health Commercial |
$1,620.20
|
| 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 |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| 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 |
$6,565.51
|
| Rate for Payer: Cash Price |
$3,645.45
|
| Rate for Payer: Cash Price |
$3,645.45
|
| Rate for Payer: Cash Price |
$3,645.45
|
| Rate for Payer: Cash Price |
$3,645.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,480.80
|
| Rate for Payer: Cigna of CA HMO |
$5,184.64
|
| Rate for Payer: Cigna of CA PPO |
$5,994.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$6,885.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,860.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,290.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$6,075.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$5,265.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,885.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,860.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,050.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,050.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,050.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,050.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
OP
|
$4,231.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$3,807.90 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| 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 |
$1,845.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.63
|
| 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 |
$1,960.77
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,384.80
|
| Rate for Payer: Cigna of CA HMO |
$2,707.84
|
| Rate for Payer: Cigna of CA PPO |
$3,130.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,353.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,230.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,230.63
|
| Rate for Payer: Galaxy Health WC |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,807.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,018.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,230.63
|
| Rate for Payer: InnovAge PACE Commercial |
$1,845.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,822.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,649.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,649.04
|
| Rate for Payer: Multiplan Commercial |
$3,173.25
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,230.63
|
| Rate for Payer: Preferred Health Network WC |
$2,000.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,304.47
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Riverside University Health System MISP |
$1,353.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,538.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,115.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,115.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,115.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,115.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,230.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,230.63
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
IP
|
$4,231.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$846.20 |
| Max. Negotiated Rate |
$3,807.90 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,692.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.40
|
| Rate for Payer: Galaxy Health WC |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,807.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,822.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,612.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,618.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.20
|
| Rate for Payer: Multiplan Commercial |
$3,173.25
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
OP
|
$4,231.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,734.71
|
| 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 |
$1,845.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.63
|
| 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 |
$1,960.77
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,384.80
|
| Rate for Payer: Cigna of CA HMO |
$2,707.84
|
| Rate for Payer: Cigna of CA PPO |
$3,130.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,353.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,230.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,230.63
|
| Rate for Payer: Galaxy Health WC |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,807.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,018.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,230.63
|
| Rate for Payer: InnovAge PACE Commercial |
$1,845.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,822.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,649.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,649.04
|
| Rate for Payer: Multiplan Commercial |
$3,173.25
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,230.63
|
| Rate for Payer: Preferred Health Network WC |
$2,000.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,304.47
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Riverside University Health System MISP |
$1,353.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,538.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,538.60
|
| 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 |
$1,230.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,230.63
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
IP
|
$4,231.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$846.20 |
| Max. Negotiated Rate |
$3,807.90 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,692.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.40
|
| Rate for Payer: Galaxy Health WC |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,807.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,822.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,612.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,618.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.20
|
| Rate for Payer: Multiplan Commercial |
$3,173.25
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
|
|
HC RMVL OF IMPLANT,SUPERFICIAL
|
Facility
|
IP
|
$10,697.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,139.40 |
| Max. Negotiated Rate |
$9,627.30 |
| Rate for Payer: Adventist Health Commercial |
$2,139.40
|
| Rate for Payer: Cash Price |
$4,813.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,557.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,278.80
|
| Rate for Payer: Galaxy Health WC |
$9,092.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,627.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,134.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,075.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,621.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.40
|
| Rate for Payer: Multiplan Commercial |
$8,022.75
|
| Rate for Payer: Networks By Design Commercial |
$6,953.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,092.45
|
|
|
HC RMVL OF IMPLANT,SUPERFICIAL
|
Facility
|
OP
|
$10,697.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$9,627.30 |
| Rate for Payer: Adventist Health Commercial |
$2,139.40
|
| 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 |
$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 |
$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 |
$3,280.13
|
| Rate for Payer: Cash Price |
$4,813.65
|
| Rate for Payer: Cash Price |
$4,813.65
|
| Rate for Payer: Cash Price |
$4,813.65
|
| Rate for Payer: Cash Price |
$4,813.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,557.60
|
| Rate for Payer: Cigna of CA HMO |
$6,846.08
|
| Rate for Payer: Cigna of CA PPO |
$7,915.78
|
| 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 |
$9,092.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,627.30
|
| 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 |
$7,134.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.40
|
| 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 |
$8,022.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$6,953.05
|
| 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 |
$9,092.45
|
| 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 |
$6,418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,348.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,348.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,348.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,348.50
|
| 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 OF IMPL FROM HAND
|
Facility
|
IP
|
$12,619.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
900501699
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,523.80 |
| Max. Negotiated Rate |
$11,357.10 |
| Rate for Payer: Adventist Health Commercial |
$2,523.80
|
| Rate for Payer: Cash Price |
$5,678.55
|
| Rate for Payer: Central Health Plan Commercial |
$10,095.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,047.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,047.60
|
| Rate for Payer: Galaxy Health WC |
$10,726.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,571.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,357.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,416.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,807.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,811.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,523.80
|
| Rate for Payer: Multiplan Commercial |
$9,464.25
|
| Rate for Payer: Networks By Design Commercial |
$8,202.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,726.15
|
|
|
HC RMVL OF IMPL FROM HAND
|
Facility
|
OP
|
$12,619.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
900501699
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,357.10 |
| Rate for Payer: Adventist Health Commercial |
$2,523.80
|
| 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 |
$5,678.55
|
| Rate for Payer: Cash Price |
$5,678.55
|
| Rate for Payer: Cash Price |
$5,678.55
|
| Rate for Payer: Cash Price |
$5,678.55
|
| Rate for Payer: Central Health Plan Commercial |
$10,095.20
|
| Rate for Payer: Cigna of CA HMO |
$8,076.16
|
| Rate for Payer: Cigna of CA PPO |
$9,338.06
|
| 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 |
$10,726.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,571.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,357.10
|
| 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 |
$8,416.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,523.80
|
| 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 |
$9,464.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$8,202.35
|
| 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 |
$10,726.15
|
| 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 |
$7,571.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,309.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,309.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,309.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,309.50
|
| 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 OF SKIN TAGS 1-15 LESIONS
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$253.79
|
| 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 |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.54
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: Cigna of CA HMO |
$396.16
|
| Rate for Payer: Cigna of CA PPO |
$458.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$371.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$371.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC RMVL OF SKIN TAGS 1-15 LESIONS
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
|
|
HC RMVL OF SKIN TAGS 1-15 LESIONS
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
|
|
HC RMVL OF SKIN TAGS 1-15 LESIONS
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| 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 |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| 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 |
$402.27
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: Cigna of CA HMO |
$396.16
|
| Rate for Payer: Cigna of CA PPO |
$458.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$371.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$309.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.50
|
| Rate for Payer: United Healthcare HMO Rider |
$309.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC RMVL OF SKIN TAGS 1-15 LESIONS
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.54
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: Cigna of CA HMO |
$396.16
|
| Rate for Payer: Cigna of CA PPO |
$458.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$371.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC RMVL OF SKIN TAGS 1-15 LESIONS
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
900501378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
|
|
HC RMVL OR BIVALVING GAUNTLET BOOT OR BODY CAST
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
900101506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.06 |
| Max. Negotiated Rate |
$911.70 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$337.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$615.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$594.93
|
| Rate for Payer: Blue Shield of California Commercial |
$618.94
|
| Rate for Payer: Blue Shield of California EPN |
$404.19
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Central Health Plan Commercial |
$810.40
|
| Rate for Payer: Cigna of CA HMO |
$648.32
|
| Rate for Payer: Cigna of CA PPO |
$749.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: InnovAge PACE Commercial |
$506.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$337.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
| Rate for Payer: Prime Health Services Medicare |
$357.70
|
| Rate for Payer: Riverside University Health System MISP |
$371.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.50
|
| Rate for Payer: United Healthcare All Other HMO |
$506.50
|
| Rate for Payer: United Healthcare HMO Rider |
$506.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC RMVL OR BIVALVING GAUNTLET BOOT OR BODY CAST
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
900101506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.60 |
| Max. Negotiated Rate |
$911.70 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Central Health Plan Commercial |
$810.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: EPIC Health Plan Senior |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$627.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.60
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
|
|
HC RMVL PERM CCM DFIB SYS DUAL LEADS
|
Facility
|
OP
|
$9,938.00
|
|
|
Service Code
|
CPT 0922T
|
| Hospital Charge Code |
906811510
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,624.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,811.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,836.59
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,950.40
|
| Rate for Payer: Cigna of CA HMO |
$6,360.32
|
| Rate for Payer: Cigna of CA PPO |
$7,354.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,944.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: InnovAge PACE Commercial |
$6,936.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,987.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,196.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,453.50
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,901.54
|
| Rate for Payer: Riverside University Health System MISP |
$5,086.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,962.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
|
|
HC RMVL PERM CCM DFIB SYS DUAL LEADS
|
Facility
|
IP
|
$9,938.00
|
|
|
Service Code
|
CPT 0922T
|
| Hospital Charge Code |
906811510
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,987.60 |
| Max. Negotiated Rate |
$8,944.20 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,950.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,975.20
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,944.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,151.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,987.60
|
| Rate for Payer: Multiplan Commercial |
$7,453.50
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
|
|
HC RMVL PERM CCM DFIB SYS PG ONLY
|
Facility
|
IP
|
$9,938.00
|
|
|
Service Code
|
CPT 0919T
|
| Hospital Charge Code |
906811507
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,987.60 |
| Max. Negotiated Rate |
$8,944.20 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,950.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,975.20
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,944.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,151.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,987.60
|
| Rate for Payer: Multiplan Commercial |
$7,453.50
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
|
|
HC RMVL PERM CCM DFIB SYS PG ONLY
|
Facility
|
OP
|
$9,938.00
|
|
|
Service Code
|
CPT 0919T
|
| Hospital Charge Code |
906811507
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,624.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,811.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,836.59
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,950.40
|
| Rate for Payer: Cigna of CA HMO |
$6,360.32
|
| Rate for Payer: Cigna of CA PPO |
$7,354.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,944.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: InnovAge PACE Commercial |
$6,936.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,987.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,196.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,453.50
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,901.54
|
| Rate for Payer: Riverside University Health System MISP |
$5,086.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,962.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC RMVL PERM CCM DFIB SYS SINGLE DFB LEAD
|
Facility
|
OP
|
$9,938.00
|
|
|
Service Code
|
CPT 0921T
|
| Hospital Charge Code |
906811509
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,624.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,811.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,836.59
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,950.40
|
| Rate for Payer: Cigna of CA HMO |
$6,360.32
|
| Rate for Payer: Cigna of CA PPO |
$7,354.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,944.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: InnovAge PACE Commercial |
$6,936.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,987.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,196.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,453.50
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,901.54
|
| Rate for Payer: Riverside University Health System MISP |
$5,086.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,962.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC RMVL PERM CCM DFIB SYS SINGLE DFB LEAD
|
Facility
|
IP
|
$9,938.00
|
|
|
Service Code
|
CPT 0921T
|
| Hospital Charge Code |
906811509
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,987.60 |
| Max. Negotiated Rate |
$8,944.20 |
| Rate for Payer: Adventist Health Commercial |
$1,987.60
|
| Rate for Payer: Cash Price |
$4,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,950.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,975.20
|
| Rate for Payer: Galaxy Health WC |
$8,447.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,944.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,628.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,151.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,987.60
|
| Rate for Payer: Multiplan Commercial |
$7,453.50
|
| Rate for Payer: Networks By Design Commercial |
$6,459.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,447.30
|
|
