|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
|
IP
|
$7,743.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,548.60 |
| Max. Negotiated Rate |
$6,968.70 |
| Rate for Payer: Cash Price |
$3,484.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,194.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,097.20
|
| Rate for Payer: Galaxy Health WC |
$6,581.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,645.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,968.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,950.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,548.60
|
| Rate for Payer: Multiplan Commercial |
$5,807.25
|
| Rate for Payer: Networks By Design Commercial |
$5,032.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,581.55
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
IP
|
$5,578.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
901200090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,115.60 |
| Max. Negotiated Rate |
$5,020.20 |
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,462.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,231.20
|
| Rate for Payer: Galaxy Health WC |
$4,741.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,346.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,020.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,720.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,125.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.60
|
| Rate for Payer: Multiplan Commercial |
$4,183.50
|
| Rate for Payer: Networks By Design Commercial |
$3,625.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,741.30
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
IP
|
$5,578.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,115.60 |
| Max. Negotiated Rate |
$5,020.20 |
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,462.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,231.20
|
| Rate for Payer: Galaxy Health WC |
$4,741.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,346.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,020.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,720.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,125.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.60
|
| Rate for Payer: Multiplan Commercial |
$4,183.50
|
| Rate for Payer: Networks By Design Commercial |
$3,625.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,741.30
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
OP
|
$5,578.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
901200090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.85 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,346.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,462.40
|
| Rate for Payer: Cigna of CA PPO |
$4,127.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$4,741.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,346.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,020.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,183.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,301.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,720.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$4,183.50
|
| Rate for Payer: Networks By Design Commercial |
$3,625.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,741.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
OP
|
$5,578.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.85 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,346.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,462.40
|
| Rate for Payer: Cigna of CA PPO |
$4,127.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$4,741.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,346.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,020.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,183.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,301.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,720.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$4,183.50
|
| Rate for Payer: Networks By Design Commercial |
$3,625.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,741.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$188.40
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: Cigna of CA PPO |
$232.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$235.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.00
|
| Rate for Payer: United Healthcare All Other HMO |
$157.00
|
| Rate for Payer: United Healthcare HMO Rider |
$157.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$197.51
|
| Rate for Payer: Blue Shield of California EPN |
$153.55
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: Cigna of CA HMO |
$200.96
|
| Rate for Payer: Cigna of CA PPO |
$232.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$235.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.00
|
| Rate for Payer: United Healthcare All Other HMO |
$157.00
|
| Rate for Payer: United Healthcare HMO Rider |
$157.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$612.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: Cigna of CA PPO |
$755.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.50
|
| Rate for Payer: United Healthcare All Other HMO |
$510.50
|
| Rate for Payer: United Healthcare HMO Rider |
$510.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.40
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$704.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$612.60
|
| Rate for Payer: Blue Shield of California Commercial |
$642.21
|
| Rate for Payer: Blue Shield of California EPN |
$499.27
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: Cigna of CA HMO |
$653.44
|
| Rate for Payer: Cigna of CA PPO |
$755.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$612.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.50
|
| Rate for Payer: United Healthcare All Other HMO |
$510.50
|
| Rate for Payer: United Healthcare HMO Rider |
$510.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.40
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$745.80
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: Cigna of CA PPO |
$919.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$932.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$745.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$621.50
|
| Rate for Payer: United Healthcare All Other HMO |
$621.50
|
| Rate for Payer: United Healthcare HMO Rider |
$621.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$621.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$1,118.70 |
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.20
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$1,118.70 |
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.20
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
|
|
HC RMVL FB CONJUNCTIVA
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
900501176
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$745.80
|
| Rate for Payer: Blue Shield of California Commercial |
$781.85
|
| Rate for Payer: Blue Shield of California EPN |
$607.83
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Central Health Plan Commercial |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$795.52
|
| Rate for Payer: Cigna of CA PPO |
$919.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$1,056.55
|
| Rate for Payer: Global Benefits Group Commercial |
$745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,118.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$932.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| Rate for Payer: Networks By Design Commercial |
$807.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,056.55
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$745.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$745.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$621.50
|
| Rate for Payer: United Healthcare All Other HMO |
$621.50
|
| Rate for Payer: United Healthcare HMO Rider |
$621.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$621.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
IP
|
$1,715.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$343.00 |
| Max. Negotiated Rate |
$1,543.50 |
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,372.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.00
|
| Rate for Payer: Galaxy Health WC |
$1,457.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,029.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,543.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$653.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$1,286.25
|
| Rate for Payer: Networks By Design Commercial |
$1,114.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,457.75
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
OP
|
$1,715.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,029.00
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,372.00
|
| Rate for Payer: Cigna of CA PPO |
$1,269.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,457.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,029.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,543.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,286.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: InnovAge PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$1,286.25
|
| Rate for Payer: Networks By Design Commercial |
$1,114.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,457.75
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Riverside University Health System MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,029.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$857.50
|
| Rate for Payer: United Healthcare All Other HMO |
$857.50
|
| Rate for Payer: United Healthcare HMO Rider |
$857.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$857.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
OP
|
$1,715.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$497.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,078.74
|
| Rate for Payer: Blue Shield of California EPN |
$838.64
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,372.00
|
| Rate for Payer: Cigna of CA HMO |
$1,097.60
|
| Rate for Payer: Cigna of CA PPO |
$1,269.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,457.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,029.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,543.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,286.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$821.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: InnovAge PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$1,286.25
|
| Rate for Payer: Networks By Design Commercial |
$1,114.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,457.75
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Riverside University Health System MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,029.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,029.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$857.50
|
| Rate for Payer: United Healthcare All Other HMO |
$857.50
|
| Rate for Payer: United Healthcare HMO Rider |
$857.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$857.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
IP
|
$1,715.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$343.00 |
| Max. Negotiated Rate |
$1,543.50 |
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,372.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.00
|
| Rate for Payer: Galaxy Health WC |
$1,457.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,029.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,543.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$653.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$1,286.25
|
| Rate for Payer: Networks By Design Commercial |
$1,114.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,457.75
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
OP
|
$1,469.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$881.40
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$661.05
|
| Rate for Payer: Cash Price |
$661.05
|
| Rate for Payer: Cash Price |
$661.05
|
| Rate for Payer: Cash Price |
$661.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,175.20
|
| Rate for Payer: Cigna of CA PPO |
$1,087.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,248.65
|
| Rate for Payer: Global Benefits Group Commercial |
$881.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,322.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,101.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: InnovAge PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$1,101.75
|
| Rate for Payer: Networks By Design Commercial |
$954.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,248.65
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Riverside University Health System MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$881.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.50
|
| Rate for Payer: United Healthcare All Other HMO |
$734.50
|
| Rate for Payer: United Healthcare HMO Rider |
$734.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$734.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
IP
|
$1,469.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.80 |
| Max. Negotiated Rate |
$1,322.10 |
| Rate for Payer: Cash Price |
$661.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.60
|
| Rate for Payer: Galaxy Health WC |
$1,248.65
|
| Rate for Payer: Global Benefits Group Commercial |
$881.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,322.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.80
|
| Rate for Payer: Multiplan Commercial |
$1,101.75
|
| Rate for Payer: Networks By Design Commercial |
$954.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,248.65
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
IP
|
$1,469.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$293.80 |
| Max. Negotiated Rate |
$1,322.10 |
| Rate for Payer: Cash Price |
$661.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.60
|
| Rate for Payer: Galaxy Health WC |
$1,248.65
|
| Rate for Payer: Global Benefits Group Commercial |
$881.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,322.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.80
|
| Rate for Payer: Multiplan Commercial |
$1,101.75
|
| Rate for Payer: Networks By Design Commercial |
$954.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,248.65
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
OP
|
$1,469.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$202.23 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$497.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$881.40
|
| Rate for Payer: Blue Shield of California Commercial |
$924.00
|
| Rate for Payer: Blue Shield of California EPN |
$718.34
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$661.05
|
| Rate for Payer: Cash Price |
$661.05
|
| Rate for Payer: Cash Price |
$661.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,175.20
|
| Rate for Payer: Cigna of CA HMO |
$940.16
|
| Rate for Payer: Cigna of CA PPO |
$1,087.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,248.65
|
| Rate for Payer: Global Benefits Group Commercial |
$881.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,322.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,101.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$821.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: InnovAge PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$1,101.75
|
| Rate for Payer: Networks By Design Commercial |
$954.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,248.65
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Riverside University Health System MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$881.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$881.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.50
|
| Rate for Payer: United Healthcare All Other HMO |
$734.50
|
| Rate for Payer: United Healthcare HMO Rider |
$734.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$734.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
