|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
OP
|
$1,715.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health 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 |
$1,029.00
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| 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 |
$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 |
$1,457.75
|
| 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 |
$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 |
$1,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.00
|
| 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 |
$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 |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
IP
|
$1,715.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
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 CORNEA W SLIT LAMP
|
Facility
|
IP
|
$1,715.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
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 W SLIT LAMP
|
Facility
|
OP
|
$1,715.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$281.81
|
| 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 |
$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 |
$159.60
|
| 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 |
$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 |
$1,457.75
|
| 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 |
$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 |
$1,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.00
|
| 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 |
$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 |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
IP
|
$7,864.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,572.80 |
| Max. Negotiated Rate |
$7,077.60 |
| Rate for Payer: Cash Price |
$3,538.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,145.60
|
| Rate for Payer: Galaxy Health WC |
$6,684.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,718.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,077.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,245.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,996.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.80
|
| Rate for Payer: Multiplan Commercial |
$5,898.00
|
| Rate for Payer: Networks By Design Commercial |
$5,111.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,684.40
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
OP
|
$7,864.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,620.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,718.40
|
| Rate for Payer: Caremore Medicare Advantage |
$3,550.26
|
| Rate for Payer: Cash Price |
$3,538.80
|
| Rate for Payer: Cash Price |
$3,538.80
|
| Rate for Payer: Cash Price |
$3,538.80
|
| Rate for Payer: Cash Price |
$3,538.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,291.20
|
| Rate for Payer: Cigna of CA PPO |
$5,819.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$6,684.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,718.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,077.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,898.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,245.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$5,898.00
|
| Rate for Payer: Networks By Design Commercial |
$5,111.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,684.40
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health System MISP |
$3,905.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,718.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,932.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,932.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,932.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.40 |
| Max. Negotiated Rate |
$753.30 |
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Central Health Plan Commercial |
$669.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.80
|
| Rate for Payer: Galaxy Health WC |
$711.45
|
| Rate for Payer: Global Benefits Group Commercial |
$502.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$753.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.40
|
| Rate for Payer: Multiplan Commercial |
$627.75
|
| Rate for Payer: Networks By Design Commercial |
$544.05
|
| Rate for Payer: Prime Health Services Commercial |
$711.45
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.88 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health 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 |
$502.20
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Central Health Plan Commercial |
$669.60
|
| Rate for Payer: Cigna of CA PPO |
$619.38
|
| 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 |
$711.45
|
| Rate for Payer: Global Benefits Group Commercial |
$502.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$753.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$627.75
|
| 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 |
$558.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.40
|
| 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 |
$627.75
|
| Rate for Payer: Networks By Design Commercial |
$544.05
|
| Rate for Payer: Prime Health Services Commercial |
$711.45
|
| 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 |
$502.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.50
|
| Rate for Payer: United Healthcare All Other HMO |
$418.50
|
| Rate for Payer: United Healthcare HMO Rider |
$418.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.50
|
| 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 EXT AUDITORY CANAL
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$140.88 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$292.30
|
| 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 |
$502.20
|
| Rate for Payer: Blue Shield of California Commercial |
$526.47
|
| Rate for Payer: Blue Shield of California EPN |
$409.29
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Central Health Plan Commercial |
$669.60
|
| Rate for Payer: Cigna of CA HMO |
$535.68
|
| Rate for Payer: Cigna of CA PPO |
$619.38
|
| 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 |
$711.45
|
| Rate for Payer: Global Benefits Group Commercial |
$502.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$753.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$627.75
|
| 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 |
$558.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.40
|
| 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 |
$627.75
|
| Rate for Payer: Networks By Design Commercial |
$544.05
|
| Rate for Payer: Prime Health Services Commercial |
$711.45
|
| 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 |
$502.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$502.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.50
|
| Rate for Payer: United Healthcare All Other HMO |
$418.50
|
| Rate for Payer: United Healthcare HMO Rider |
$418.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.50
|
| 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 EXT AUDITORY CANAL
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$167.40 |
| Max. Negotiated Rate |
$753.30 |
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Central Health Plan Commercial |
$669.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.80
|
| Rate for Payer: Galaxy Health WC |
$711.45
|
| Rate for Payer: Global Benefits Group Commercial |
$502.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$753.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.40
|
| Rate for Payer: Multiplan Commercial |
$627.75
|
| Rate for Payer: Networks By Design Commercial |
$544.05
|
| Rate for Payer: Prime Health Services Commercial |
$711.45
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
OP
|
$3,234.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$1,940.40
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,455.30
|
| Rate for Payer: Cash Price |
$1,455.30
|
| Rate for Payer: Cash Price |
$1,455.30
|
| Rate for Payer: Cash Price |
$1,455.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,587.20
|
| Rate for Payer: Cigna of CA PPO |
$2,393.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$2,748.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,940.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,910.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,425.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,425.50
|
| Rate for Payer: Networks By Design Commercial |
$2,102.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,748.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,940.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,617.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,617.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,617.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,617.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
IP
|
$3,234.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$646.80 |
| Max. Negotiated Rate |
$2,910.60 |
| Rate for Payer: Cash Price |
$1,455.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,587.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,293.60
|
| Rate for Payer: Galaxy Health WC |
$2,748.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,940.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,910.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,232.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.80
|
| Rate for Payer: Multiplan Commercial |
$2,425.50
|
| Rate for Payer: Networks By Design Commercial |
$2,102.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,748.90
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
OP
|
$7,945.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,150.50 |
| 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 |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$4,767.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,356.00
|
| Rate for Payer: Cigna of CA PPO |
$5,879.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,150.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,958.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$5,958.75
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,767.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,972.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,972.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,972.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
|
IP
|
$7,945.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,589.00 |
| Max. Negotiated Rate |
$7,150.50 |
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,356.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,178.00
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,150.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,027.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.00
|
| Rate for Payer: Multiplan Commercial |
$5,958.75
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$2,980.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$596.00 |
| Max. Negotiated Rate |
$2,682.00 |
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,384.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,192.00
|
| Rate for Payer: Galaxy Health WC |
$2,533.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,788.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,682.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,987.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,135.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.00
|
| Rate for Payer: Multiplan Commercial |
$2,235.00
|
| Rate for Payer: Networks By Design Commercial |
$1,937.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,533.00
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
IP
|
$2,980.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$596.00 |
| Max. Negotiated Rate |
$2,682.00 |
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,384.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,192.00
|
| Rate for Payer: Galaxy Health WC |
$2,533.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,788.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,682.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,987.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,135.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.00
|
| Rate for Payer: Multiplan Commercial |
$2,235.00
|
| Rate for Payer: Networks By Design Commercial |
$1,937.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,533.00
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$2,980.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| 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 |
$1,788.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,874.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.22
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,384.00
|
| Rate for Payer: Cigna of CA HMO |
$1,907.20
|
| Rate for Payer: Cigna of CA PPO |
$2,205.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,533.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,788.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,682.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,235.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,987.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,235.00
|
| Rate for Payer: Networks By Design Commercial |
$1,937.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,533.00
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,788.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,788.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,490.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,490.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
|
OP
|
$2,980.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| 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 |
$1,788.00
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,384.00
|
| Rate for Payer: Cigna of CA PPO |
$2,205.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,533.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,788.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,682.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,235.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,987.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,235.00
|
| Rate for Payer: Networks By Design Commercial |
$1,937.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,533.00
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,788.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,490.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,490.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
OP
|
$5,206.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$867.94 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,911.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| 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 |
$3,123.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,274.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,545.73
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$2,342.70
|
| Rate for Payer: Cash Price |
$2,342.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,164.80
|
| Rate for Payer: Cigna of CA HMO |
$3,331.84
|
| Rate for Payer: Cigna of CA PPO |
$3,852.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$4,425.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,123.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,685.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,904.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,804.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: InnovAge PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,472.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,041.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$3,904.50
|
| Rate for Payer: Networks By Design Commercial |
$3,383.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,425.10
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health System MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,123.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,123.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,603.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,603.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,603.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
OP
|
$5,206.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| 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 |
$3,123.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$2,342.70
|
| Rate for Payer: Cash Price |
$2,342.70
|
| Rate for Payer: Cash Price |
$2,342.70
|
| Rate for Payer: Cash Price |
$2,342.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,164.80
|
| Rate for Payer: Cigna of CA PPO |
$3,852.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$4,425.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,123.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,685.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,904.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: InnovAge PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,472.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,041.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$3,904.50
|
| Rate for Payer: Networks By Design Commercial |
$3,383.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,425.10
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health System MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,123.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,603.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,603.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,603.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
IP
|
$5,206.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,041.20 |
| Max. Negotiated Rate |
$4,685.40 |
| Rate for Payer: Cash Price |
$2,342.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.40
|
| Rate for Payer: Galaxy Health WC |
$4,425.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,123.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,685.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,472.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,983.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,041.20
|
| Rate for Payer: Multiplan Commercial |
$3,904.50
|
| Rate for Payer: Networks By Design Commercial |
$3,383.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,425.10
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
IP
|
$5,206.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,041.20 |
| Max. Negotiated Rate |
$4,685.40 |
| Rate for Payer: Cash Price |
$2,342.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.40
|
| Rate for Payer: Galaxy Health WC |
$4,425.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,123.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,685.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,472.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,983.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,041.20
|
| Rate for Payer: Multiplan Commercial |
$3,904.50
|
| Rate for Payer: Networks By Design Commercial |
$3,383.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,425.10
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH DEEP
|
Facility
|
IP
|
$8,426.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
900501534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,685.20 |
| Max. Negotiated Rate |
$7,583.40 |
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,740.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,370.40
|
| Rate for Payer: Galaxy Health WC |
$7,162.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,055.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,583.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,620.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,210.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,685.20
|
| Rate for Payer: Multiplan Commercial |
$6,319.50
|
| Rate for Payer: Networks By Design Commercial |
$5,476.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,162.10
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH DEEP
|
Facility
|
OP
|
$8,426.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
900501534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| 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 |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| 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 |
$5,055.60
|
| Rate for Payer: Caremore Medicare Advantage |
$3,550.26
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,740.80
|
| Rate for Payer: Cigna of CA PPO |
$6,235.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$7,162.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,055.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,583.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,319.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,620.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,685.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$6,319.50
|
| Rate for Payer: Networks By Design Commercial |
$5,476.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,162.10
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health System MISP |
$3,905.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,055.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,213.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,213.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,213.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH SMPL
|
Facility
|
IP
|
$1,935.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
900501492
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.00 |
| Max. Negotiated Rate |
$1,741.50 |
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,548.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.00
|
| Rate for Payer: Galaxy Health WC |
$1,644.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,161.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,741.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.00
|
| Rate for Payer: Multiplan Commercial |
$1,451.25
|
| Rate for Payer: Networks By Design Commercial |
$1,257.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,644.75
|
|
