|
HC RMVL FB MSCLE/TNDN SHEATH SMPL
|
Facility
OP
|
$1,935.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
900501492
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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: BCBS Transplant Transplant |
$1,161.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,548.00
|
| Rate for Payer: Cigna of CA PPO |
$1,431.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| 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 |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,451.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: 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 |
$1,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.00
|
| 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 |
$1,451.25
|
| Rate for Payer: Networks By Design Commercial |
$1,257.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,644.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,161.00
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$967.50
|
| Rate for Payer: United Healthcare All Other HMO |
$967.50
|
| Rate for Payer: United Healthcare HMO Rider |
$967.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$967.50
|
| 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 FB OUTER EAR CANAL W/ANES
|
Facility
IP
|
$8,758.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,751.60 |
| Max. Negotiated Rate |
$7,882.20 |
| Rate for Payer: Cash Price |
$3,941.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,006.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,503.20
|
| Rate for Payer: Galaxy Health WC |
$7,444.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,254.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,882.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,841.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.60
|
| Rate for Payer: Multiplan Commercial |
$6,568.50
|
| Rate for Payer: Networks By Design Commercial |
$5,692.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,444.30
|
|
|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
OP
|
$8,758.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,882.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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: BCBS Transplant Transplant |
$5,254.80
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,941.10
|
| Rate for Payer: Cash Price |
$3,941.10
|
| Rate for Payer: Cash Price |
$3,941.10
|
| Rate for Payer: Cash Price |
$3,941.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,006.40
|
| Rate for Payer: Cigna of CA PPO |
$6,480.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| 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 |
$7,444.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,254.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,882.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,568.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: 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 |
$5,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.60
|
| 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 |
$6,568.50
|
| Rate for Payer: Networks By Design Commercial |
$5,692.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,444.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,254.80
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,254.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,379.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,379.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,379.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,379.00
|
| 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 FB PHARYNGEAL
|
Facility
OP
|
$814.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.80 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$488.40
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA PPO |
$602.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| 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 |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$610.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Innovage PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| 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 |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: Riverside University Health MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.00
|
| Rate for Payer: United Healthcare All Other HMO |
$407.00
|
| Rate for Payer: United Healthcare HMO Rider |
$407.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.00
|
| 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 PHARYNGEAL
|
Facility
IP
|
$814.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$732.60 |
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
|
|
HC RMVL FB PHARYNGEAL
|
Facility
IP
|
$814.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$732.60 |
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
|
|
HC RMVL FB PHARYNGEAL
|
Facility
OP
|
$814.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$497.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$488.40
|
| Rate for Payer: Blue Shield of California Commercial |
$512.01
|
| Rate for Payer: Blue Shield of California EPN |
$398.05
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$520.96
|
| Rate for Payer: Cigna of CA PPO |
$602.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| 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 |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$610.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: IEHP medi-cal |
$821.40
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Innovage PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| 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 |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: Riverside University Health MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.00
|
| Rate for Payer: United Healthcare All Other HMO |
$407.00
|
| Rate for Payer: United Healthcare HMO Rider |
$407.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.00
|
| 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 F.B. UPPER ARM/ELBOW,SUBC
|
Facility
IP
|
$1,935.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
516
|
| 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: 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
|
|
|
HC RMVL F.B. UPPER ARM/ELBOW,SUBC
|
Facility
OP
|
$1,935.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$387.00 |
| Max. Negotiated Rate |
$3,342.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$714.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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: BCBS Transplant Transplant |
$1,161.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,217.12
|
| Rate for Payer: Blue Shield of California EPN |
$946.22
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,548.00
|
| Rate for Payer: Cigna of CA HMO |
$1,238.40
|
| Rate for Payer: Cigna of CA PPO |
$1,431.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| 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 |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,451.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: 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 |
$1,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.00
|
| 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 |
$1,451.25
|
| Rate for Payer: Networks By Design Commercial |
$1,257.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,644.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,161.00
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,161.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,161.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$967.50
|
| Rate for Payer: United Healthcare All Other HMO |
$967.50
|
| Rate for Payer: United Healthcare HMO Rider |
$967.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$967.50
|
| 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. UPPER ARM/ELBOW,SUBC
|
Facility
IP
|
$1,935.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
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: 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
|
|
|
HC RMVL F.B. UPPER ARM/ELBOW,SUBC
|
Facility
OP
|
$1,935.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.00 |
| Max. Negotiated Rate |
$3,322.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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: BCBS Transplant Transplant |
$1,161.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Cash Price |
$870.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,548.00
|
| Rate for Payer: Cigna of CA PPO |
$1,431.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| 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 |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,451.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: 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 |
$1,290.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.00
|
| 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 |
$1,451.25
|
| Rate for Payer: Networks By Design Commercial |
$1,257.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,644.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,161.00
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$967.50
|
| Rate for Payer: United Healthcare All Other HMO |
$967.50
|
| Rate for Payer: United Healthcare HMO Rider |
$967.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$967.50
|
| 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 FECAL IMPACTION W/ANESTHE
|
Facility
OP
|
$5,598.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
900501608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,038.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| 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: BCBS Transplant Transplant |
$3,358.80
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Cash Price |
$2,519.10
|
| Rate for Payer: Cash Price |
$2,519.10
|
| Rate for Payer: Cash Price |
$2,519.10
|
| Rate for Payer: Cash Price |
$2,519.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,478.40
|
| Rate for Payer: Cigna of CA PPO |
$4,142.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$4,758.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,038.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,198.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Innovage PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,733.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$4,198.50
|
| Rate for Payer: Networks By Design Commercial |
$3,638.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,758.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,358.80
|
| Rate for Payer: Riverside University Health MISP |
$1,621.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,799.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,799.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,799.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC RMVL FECAL IMPACTION W/ANESTHE
|
Facility
IP
|
$5,598.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
900501608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,119.60 |
| Max. Negotiated Rate |
$5,038.20 |
| Rate for Payer: Cash Price |
$2,519.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,478.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.20
|
| Rate for Payer: Galaxy Health WC |
$4,758.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,038.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,733.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,119.60
|
| Rate for Payer: Multiplan Commercial |
$4,198.50
|
| Rate for Payer: Networks By Design Commercial |
$3,638.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,758.30
|
|
|
HC RMVL FOREARM LESION SUBCU
|
Facility
IP
|
$8,426.00
|
|
|
Service Code
|
CPT 25075
|
| Hospital Charge Code |
902890327
|
|
Hospital Revenue Code
|
516
|
| 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: 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 FOREARM LESION SUBCU
|
Facility
OP
|
$8,426.00
|
|
|
Service Code
|
CPT 25075
|
| Hospital Charge Code |
902890327
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,685.20 |
| Max. Negotiated Rate |
$7,583.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$5,055.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,299.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,120.31
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| 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 HMO |
$5,392.64
|
| Rate for Payer: Cigna of CA PPO |
$6,235.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| 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 |
$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 Transplant Other |
$6,319.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: 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 |
$5,620.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,685.20
|
| 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 |
$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 |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,055.60
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,055.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$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 |
$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 FOREIGN BODY EYELID
|
Facility
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$363.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant 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 |
$363.98
|
| 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 |
$545.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| 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 Transplant Other |
$932.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: IEHP medi-cal |
$600.57
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Innovage PACE Commercial |
$545.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| 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 |
$385.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$745.80
|
| Rate for Payer: Riverside University Health MISP |
$400.38
|
| 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 |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC RMVL FOREIGN BODY EYELID
|
Facility
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$363.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| 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: BCBS Transplant 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 |
$363.98
|
| 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 |
$545.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| 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 Transplant Other |
$932.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: IEHP medi-cal |
$600.57
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Innovage PACE Commercial |
$545.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| 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 |
$385.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$745.80
|
| Rate for Payer: Riverside University Health MISP |
$400.38
|
| 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 |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC RMVL FOREIGN BODY EYELID
|
Facility
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
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: 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 FOREIGN BODY EYELID
|
Facility
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
490
|
| 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: 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 FOREIGN BODY LARYNX
|
Facility
OP
|
$667.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.40 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| 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: BCBS Transplant Transplant |
$400.20
|
| Rate for Payer: Caremore Medicare Advantage |
$247.49
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: Cigna of CA PPO |
$493.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$500.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$405.88
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Innovage PACE Commercial |
$371.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$500.25
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
| Rate for Payer: Prime Health Services Medicare |
$262.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$400.20
|
| Rate for Payer: Riverside University Health MISP |
$272.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.50
|
| Rate for Payer: United Healthcare All Other HMO |
$333.50
|
| Rate for Payer: United Healthcare HMO Rider |
$333.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
OP
|
$667.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$247.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| 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: BCBS Transplant Transplant |
$400.20
|
| Rate for Payer: Blue Shield of California Commercial |
$419.54
|
| Rate for Payer: Blue Shield of California EPN |
$326.16
|
| Rate for Payer: Caremore Medicare Advantage |
$247.49
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: Cigna of CA HMO |
$426.88
|
| Rate for Payer: Cigna of CA PPO |
$493.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$500.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$405.88
|
| Rate for Payer: IEHP medi-cal |
$408.36
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Innovage PACE Commercial |
$371.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$500.25
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
| Rate for Payer: Prime Health Services Medicare |
$262.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$400.20
|
| Rate for Payer: Riverside University Health MISP |
$272.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.50
|
| Rate for Payer: United Healthcare All Other HMO |
$333.50
|
| Rate for Payer: United Healthcare HMO Rider |
$333.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
IP
|
$667.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$600.30 |
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.80
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| Rate for Payer: Multiplan Commercial |
$500.25
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
IP
|
$667.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$600.30 |
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.80
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| Rate for Payer: Multiplan Commercial |
$500.25
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
OP
|
$1,116.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$76.42 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$669.60
|
| Rate for Payer: Blue Shield of California Commercial |
$701.96
|
| Rate for Payer: Blue Shield of California EPN |
$545.72
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: Cigna of CA HMO |
$714.24
|
| Rate for Payer: Cigna of CA PPO |
$825.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| 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 |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$837.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: IEHP medi-cal |
$126.09
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Innovage PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| 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 |
$837.00
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$669.60
|
| Rate for Payer: Riverside University Health MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO |
$558.00
|
| Rate for Payer: United Healthcare HMO Rider |
$558.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| 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 IMPACTED CERUMEN
|
Facility
IP
|
$1,116.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
|
