|
HC RMVL IMPACTED CERUMEN
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$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: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$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) Other |
$837.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| 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: Riverside University Health System 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: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| 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
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
OP
|
$5,583.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$301.51 |
| Max. Negotiated Rate |
$6,445.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| 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 |
$3,349.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,511.71
|
| Rate for Payer: Blue Shield of California EPN |
$2,730.09
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,466.40
|
| Rate for Payer: Cigna of CA HMO |
$3,573.12
|
| Rate for Payer: Cigna of CA PPO |
$4,131.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$4,745.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,024.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,187.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,723.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$4,187.25
|
| Rate for Payer: Networks By Design Commercial |
$3,628.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,745.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,791.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,791.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,791.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,791.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
OP
|
$5,583.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.51 |
| Max. Negotiated Rate |
$6,406.14 |
| 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 |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| 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 |
$3,349.80
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,466.40
|
| Rate for Payer: Cigna of CA PPO |
$4,131.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$4,745.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,024.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,187.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,723.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$4,187.25
|
| Rate for Payer: Networks By Design Commercial |
$3,628.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,745.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,791.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,791.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,791.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,791.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
IP
|
$5,583.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,116.60 |
| Max. Negotiated Rate |
$5,024.70 |
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,233.20
|
| Rate for Payer: Galaxy Health WC |
$4,745.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,024.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,723.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.60
|
| Rate for Payer: Multiplan Commercial |
$4,187.25
|
| Rate for Payer: Networks By Design Commercial |
$3,628.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,745.55
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
IP
|
$5,583.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,116.60 |
| Max. Negotiated Rate |
$5,024.70 |
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,233.20
|
| Rate for Payer: Galaxy Health WC |
$4,745.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,024.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,723.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.60
|
| Rate for Payer: Multiplan Commercial |
$4,187.25
|
| Rate for Payer: Networks By Design Commercial |
$3,628.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,745.55
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
IP
|
$7,997.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906820266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,599.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,397.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,198.80
|
| Rate for Payer: Galaxy Health WC |
$6,797.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,798.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,197.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,334.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,046.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,599.40
|
| Rate for Payer: Multiplan Commercial |
$5,997.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,797.45
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
IP
|
$7,997.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,599.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,397.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,198.80
|
| Rate for Payer: Galaxy Health WC |
$6,797.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,798.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,197.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,334.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,046.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,599.40
|
| Rate for Payer: Multiplan Commercial |
$5,997.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,797.45
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
OP
|
$7,997.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906803968
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$50.94 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,797.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,398.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,398.35
|
| 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 |
$4,798.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,397.60
|
| Rate for Payer: Cigna of CA PPO |
$5,917.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,797.45
|
| Rate for Payer: Dignity Health Media |
$6,797.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,797.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,198.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,198.80
|
| Rate for Payer: Galaxy Health WC |
$6,797.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,798.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,197.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,997.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,798.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,334.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,599.40
|
| Rate for Payer: Multiplan Commercial |
$5,997.75
|
| Rate for Payer: Networks By Design Commercial |
$5,198.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,797.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,198.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,798.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,797.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,797.45
|
|
|
HC RMVL INTRA AORTIC BLLN AST DVC
|
Facility
|
OP
|
$7,997.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
906820266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$50.94 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,797.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,398.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,398.35
|
| 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 |
$4,798.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Cash Price |
$3,598.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,397.60
|
| Rate for Payer: Cigna of CA PPO |
$5,917.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,797.45
|
| Rate for Payer: Dignity Health Media |
$6,797.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,797.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,198.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,198.80
|
| Rate for Payer: Galaxy Health WC |
$6,797.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,798.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,197.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,997.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,798.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,334.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,599.40
|
| Rate for Payer: Multiplan Commercial |
$5,997.75
|
| Rate for Payer: Networks By Design Commercial |
$5,198.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,797.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,198.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,798.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,797.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,797.45
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$1,304.10 |
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.60
|
| Rate for Payer: Galaxy Health WC |
$1,231.65
|
| Rate for Payer: Global Benefits Group Commercial |
$869.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,304.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$966.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$1,086.75
|
| Rate for Payer: Networks By Design Commercial |
$941.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,231.65
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$652.53
|
| 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 |
$869.40
|
| Rate for Payer: Blue Shield of California Commercial |
$911.42
|
| Rate for Payer: Blue Shield of California EPN |
$708.56
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,159.20
|
| Rate for Payer: Cigna of CA HMO |
$927.36
|
| Rate for Payer: Cigna of CA PPO |
$1,072.26
|
| 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 |
$1,231.65
|
| Rate for Payer: Global Benefits Group Commercial |
$869.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,304.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,086.75
|
| 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 |
$966.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.80
|
| 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 |
$1,086.75
|
| Rate for Payer: Networks By Design Commercial |
$941.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,231.65
|
| 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 |
$869.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$869.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$724.50
|
| Rate for Payer: United Healthcare All Other HMO |
$724.50
|
| Rate for Payer: United Healthcare HMO Rider |
$724.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.50
|
| 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 INTRANASAL FB
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$1,304.10 |
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.60
|
| Rate for Payer: Galaxy Health WC |
$1,231.65
|
| Rate for Payer: Global Benefits Group Commercial |
$869.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,304.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$966.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$1,086.75
|
| Rate for Payer: Networks By Design Commercial |
$941.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,231.65
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health 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 |
$869.40
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,159.20
|
| Rate for Payer: Cigna of CA PPO |
$1,072.26
|
| 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 |
$1,231.65
|
| Rate for Payer: Global Benefits Group Commercial |
$869.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,304.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,086.75
|
| 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 |
$966.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.80
|
| 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 |
$1,086.75
|
| Rate for Payer: Networks By Design Commercial |
$941.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,231.65
|
| 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 |
$869.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$724.50
|
| Rate for Payer: United Healthcare All Other HMO |
$724.50
|
| Rate for Payer: United Healthcare HMO Rider |
$724.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.50
|
| 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 INTRANASAL LESION
|
Facility
|
OP
|
$5,771.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| 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 |
$3,462.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$2,596.95
|
| Rate for Payer: Cash Price |
$2,596.95
|
| Rate for Payer: Cash Price |
$2,596.95
|
| Rate for Payer: Cash Price |
$2,596.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,616.80
|
| Rate for Payer: Cigna of CA PPO |
$4,270.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$4,905.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,462.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,193.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,328.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,849.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,154.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$4,328.25
|
| Rate for Payer: Networks By Design Commercial |
$3,751.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,905.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,462.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC RMVL INTRANASAL LESION
|
Facility
|
IP
|
$5,771.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,154.20 |
| Max. Negotiated Rate |
$5,193.90 |
| Rate for Payer: Cash Price |
$2,596.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,616.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,308.40
|
| Rate for Payer: Galaxy Health WC |
$4,905.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,462.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,193.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,849.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,198.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,154.20
|
| Rate for Payer: Multiplan Commercial |
$4,328.25
|
| Rate for Payer: Networks By Design Commercial |
$3,751.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,905.35
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
IP
|
$6,125.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$5,512.50 |
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,450.00
|
| Rate for Payer: Galaxy Health WC |
$5,206.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,675.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,512.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,085.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,333.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,225.00
|
| Rate for Payer: Multiplan Commercial |
$4,593.75
|
| Rate for Payer: Networks By Design Commercial |
$3,981.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,206.25
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
OP
|
$6,125.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$6,597.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| 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: Blue Distinction Transplant |
$3,675.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,900.00
|
| Rate for Payer: Cigna of CA PPO |
$4,532.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$5,206.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,675.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,512.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,593.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,085.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$4,593.75
|
| Rate for Payer: Networks By Design Commercial |
$3,981.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,206.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,062.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,264.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| 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 |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,149.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,670.91
|
| Rate for Payer: Caremore Medicare Advantage |
$1,264.97
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA HMO |
$2,186.88
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Media |
$1,264.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,707.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,264.97
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,074.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,087.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,264.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,897.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,695.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,695.06
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,340.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,391.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,708.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,708.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,708.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,708.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| 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 |
$2,050.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1,264.97
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Media |
$1,264.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,707.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,264.97
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,074.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,264.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,897.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,695.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,695.06
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,340.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,391.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,708.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,708.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,708.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,708.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC RMVL OF IMPLANT,SUPERFICIAL
|
Facility
|
IP
|
$8,089.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,617.80 |
| Max. Negotiated Rate |
$7,280.10 |
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,471.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,235.60
|
| Rate for Payer: Galaxy Health WC |
$6,875.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,853.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,280.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,395.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,081.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,617.80
|
| Rate for Payer: Multiplan Commercial |
$6,066.75
|
| Rate for Payer: Networks By Design Commercial |
$5,257.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,875.65
|
|
|
HC RMVL OF IMPLANT,SUPERFICIAL
|
Facility
|
OP
|
$8,089.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$7,280.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| 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 |
$4,853.40
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,471.20
|
| Rate for Payer: Cigna of CA PPO |
$5,985.86
|
| 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 |
$6,875.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,853.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,280.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,066.75
|
| 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 |
$5,395.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,617.80
|
| 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 |
$6,066.75
|
| Rate for Payer: Networks By Design Commercial |
$5,257.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,875.65
|
| 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 |
$4,853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,044.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,044.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,044.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,044.50
|
| 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 OF IMPLANT,SUPERFICIAL
|
Facility
|
IP
|
$8,089.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,617.80 |
| Max. Negotiated Rate |
$7,280.10 |
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,471.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,235.60
|
| Rate for Payer: Galaxy Health WC |
$6,875.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,853.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,280.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,395.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,081.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,617.80
|
| Rate for Payer: Multiplan Commercial |
$6,066.75
|
| Rate for Payer: Networks By Design Commercial |
$5,257.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,875.65
|
|
