|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
OP
|
$2,801.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$560.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,260.45
|
| Rate for Payer: Cash Price |
$1,260.45
|
| Rate for Payer: Cash Price |
$1,260.45
|
| Rate for Payer: Cigna of CA HMO |
$1,792.64
|
| Rate for Payer: Cigna of CA PPO |
$2,072.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,960.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$2,380.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,680.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,778.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$2,240.80
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,820.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,380.85
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,680.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,400.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,400.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,400.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,400.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
OP
|
$2,649.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$529.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,192.05
|
| Rate for Payer: Cash Price |
$1,192.05
|
| Rate for Payer: Cash Price |
$1,192.05
|
| Rate for Payer: Cigna of CA HMO |
$1,695.36
|
| Rate for Payer: Cigna of CA PPO |
$1,960.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,854.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,251.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,589.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,682.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$2,119.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,721.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,251.65
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,589.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,324.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,324.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
IP
|
$2,649.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$529.80 |
| Max. Negotiated Rate |
$2,251.65 |
| Rate for Payer: Adventist Health Commercial |
$529.80
|
| Rate for Payer: Cash Price |
$1,192.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,854.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,059.60
|
| Rate for Payer: Galaxy Health WC |
$2,251.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,589.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,682.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,562.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.76
|
| Rate for Payer: Multiplan Commercial |
$2,119.20
|
| Rate for Payer: Networks By Design Commercial |
$1,721.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,251.65
|
|
|
HC SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
OP
|
$3,351.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.85 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$670.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: Cigna of CA HMO |
$2,144.64
|
| Rate for Payer: Cigna of CA PPO |
$2,479.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,345.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,848.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,010.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,127.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$618.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$2,680.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,178.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,848.35
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,010.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,675.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,675.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,675.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
IP
|
$3,351.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$670.20 |
| Max. Negotiated Rate |
$2,848.35 |
| Rate for Payer: Adventist Health Commercial |
$670.20
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,345.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,340.40
|
| Rate for Payer: Galaxy Health WC |
$2,848.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,010.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,127.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,977.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.24
|
| Rate for Payer: Multiplan Commercial |
$2,680.80
|
| Rate for Payer: Networks By Design Commercial |
$2,178.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,848.35
|
|
|
HC SIMULATION 3D COMPUTER
|
Facility
|
OP
|
$14,357.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$721.98 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$2,871.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,413.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,670.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,958.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,780.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,204.76
|
| Rate for Payer: Blue Shield of California Commercial |
$6,044.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9,159.77
|
| Rate for Payer: Cash Price |
$6,460.65
|
| Rate for Payer: Cash Price |
$6,460.65
|
| Rate for Payer: Cash Price |
$6,460.65
|
| Rate for Payer: Cash Price |
$6,460.65
|
| Rate for Payer: Cigna of CA HMO |
$9,188.48
|
| Rate for Payer: Cigna of CA PPO |
$10,624.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,670.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,958.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,780.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,049.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,937.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1,958.24
|
| Rate for Payer: Galaxy Health WC |
$12,203.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,614.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,919.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$721.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,780.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,116.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$816.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,492.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,445.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,243.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,385.49
|
| Rate for Payer: Multiplan Commercial |
$11,485.60
|
| Rate for Payer: Networks By Design Commercial |
$9,332.05
|
| Rate for Payer: Prime Health Services Commercial |
$12,203.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,614.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,670.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,958.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.22
|
|
|
HC SIMULATION 3D COMPUTER
|
Facility
|
IP
|
$14,357.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,871.40 |
| Max. Negotiated Rate |
$12,203.45 |
| Rate for Payer: Adventist Health Commercial |
$2,871.40
|
| Rate for Payer: Cash Price |
$6,460.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,049.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,742.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,742.80
|
| Rate for Payer: Galaxy Health WC |
$12,203.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,614.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,116.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,470.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,445.68
|
| Rate for Payer: Multiplan Commercial |
$11,485.60
|
| Rate for Payer: Networks By Design Commercial |
$9,332.05
|
| Rate for Payer: Prime Health Services Commercial |
$12,203.45
|
|
|
HC SIMULATION COMPLEX
|
Facility
|
OP
|
$3,556.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$261.90 |
| Max. Negotiated Rate |
$3,256.83 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,256.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,669.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,497.08
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cigna of CA HMO |
$2,275.84
|
| Rate for Payer: Cigna of CA PPO |
$2,631.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,489.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$3,022.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,133.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$261.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,258.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$296.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$2,844.80
|
| Rate for Payer: Networks By Design Commercial |
$2,311.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,022.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,133.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC SIMULATION COMPLEX
|
Facility
|
IP
|
$3,556.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$711.20 |
| Max. Negotiated Rate |
$3,022.60 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,489.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,422.40
|
| Rate for Payer: Galaxy Health WC |
$3,022.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,133.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,258.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,098.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.44
|
| Rate for Payer: Multiplan Commercial |
$2,844.80
|
| Rate for Payer: Networks By Design Commercial |
$2,311.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,022.60
|
|
|
HC SIMULATION INTER
|
Facility
|
IP
|
$1,254.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Adventist Health Commercial |
$250.80
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$501.60
|
| Rate for Payer: Galaxy Health WC |
$1,065.90
|
| Rate for Payer: Global Benefits Group Commercial |
$752.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$796.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$739.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.96
|
| Rate for Payer: Multiplan Commercial |
$1,003.20
|
| Rate for Payer: Networks By Design Commercial |
$815.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.90
|
|
|
HC SIMULATION INTER
|
Facility
|
OP
|
$1,254.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$213.39 |
| Max. Negotiated Rate |
$2,007.59 |
| Rate for Payer: Adventist Health Commercial |
$250.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,007.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,434.88
|
| Rate for Payer: Blue Shield of California Commercial |
$800.05
|
| Rate for Payer: Blue Shield of California Commercial |
$527.93
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Cigna of CA HMO |
$802.56
|
| Rate for Payer: Cigna of CA PPO |
$927.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$1,065.90
|
| Rate for Payer: Global Benefits Group Commercial |
$752.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$796.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$1,003.20
|
| Rate for Payer: Networks By Design Commercial |
$815.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$752.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
IP
|
$1,702.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$340.40 |
| Max. Negotiated Rate |
$1,446.70 |
| Rate for Payer: Adventist Health Commercial |
$340.40
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,191.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$680.80
|
| Rate for Payer: EPIC Health Plan Senior |
$680.80
|
| Rate for Payer: Galaxy Health WC |
$1,446.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,080.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,004.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.48
|
| Rate for Payer: Multiplan Commercial |
$1,361.60
|
| Rate for Payer: Networks By Design Commercial |
$1,106.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,446.70
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
OP
|
$1,702.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$340.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,108.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$893.35
|
| Rate for Payer: Blue Shield of California Commercial |
$716.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,085.88
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna of CA HMO |
$1,089.28
|
| Rate for Payer: Cigna of CA PPO |
$1,259.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,191.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.24
|
| Rate for Payer: EPIC Health Plan Senior |
$190.16
|
| Rate for Payer: Galaxy Health WC |
$1,446.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,080.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$1,361.60
|
| Rate for Payer: Networks By Design Commercial |
$1,106.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,446.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,021.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Adventist Health Commercial |
$212.80
|
| Rate for Payer: Adventist Health Commercial |
$173.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$829.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$829.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.28
|
| Rate for Payer: Blue Shield of California Commercial |
$398.76
|
| Rate for Payer: Blue Shield of California Commercial |
$490.50
|
| Rate for Payer: Blue Shield of California Commercial |
$602.90
|
| Rate for Payer: Blue Shield of California Commercial |
$741.61
|
| Rate for Payer: Cash Price |
$389.25
|
| Rate for Payer: Cash Price |
$389.25
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cigna of CA HMO |
$553.60
|
| Rate for Payer: Cigna of CA HMO |
$680.96
|
| Rate for Payer: Cigna of CA PPO |
$787.36
|
| Rate for Payer: Cigna of CA PPO |
$640.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$605.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Galaxy Health WC |
$735.25
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Global Benefits Group Commercial |
$519.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$549.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$407.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$407.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$692.00
|
| Rate for Payer: Multiplan Commercial |
$851.20
|
| Rate for Payer: Networks By Design Commercial |
$562.25
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
| Rate for Payer: Prime Health Services Commercial |
$735.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$638.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$519.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$638.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$519.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Adventist Health Commercial |
$212.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.60
|
| Rate for Payer: EPIC Health Plan Senior |
$425.60
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$627.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.36
|
| Rate for Payer: Multiplan Commercial |
$851.20
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Adventist Health Commercial |
$212.80
|
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$754.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$754.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.40
|
| Rate for Payer: Blue Shield of California Commercial |
$362.35
|
| Rate for Payer: Blue Shield of California Commercial |
$490.50
|
| Rate for Payer: Blue Shield of California Commercial |
$547.84
|
| Rate for Payer: Blue Shield of California Commercial |
$741.61
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA HMO |
$680.96
|
| Rate for Payer: Cigna of CA PPO |
$787.36
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$628.80
|
| Rate for Payer: Multiplan Commercial |
$851.20
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$638.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$638.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Adventist Health Commercial |
$212.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.60
|
| Rate for Payer: EPIC Health Plan Senior |
$425.60
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$627.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.36
|
| Rate for Payer: Multiplan Commercial |
$851.20
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
OP
|
$1,451.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.21 |
| Max. Negotiated Rate |
$1,233.35 |
| Rate for Payer: Adventist Health Commercial |
$290.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$256.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.06
|
| Rate for Payer: Blue Shield of California Commercial |
$610.87
|
| Rate for Payer: Blue Shield of California Commercial |
$925.74
|
| Rate for Payer: Cash Price |
$652.95
|
| Rate for Payer: Cash Price |
$652.95
|
| Rate for Payer: Cigna of CA HMO |
$928.64
|
| Rate for Payer: Cigna of CA PPO |
$1,073.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,015.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$1,233.35
|
| Rate for Payer: Global Benefits Group Commercial |
$870.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$921.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,160.80
|
| Rate for Payer: Networks By Design Commercial |
$943.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,233.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
IP
|
$1,451.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.20 |
| Max. Negotiated Rate |
$1,233.35 |
| Rate for Payer: Adventist Health Commercial |
$290.20
|
| Rate for Payer: Cash Price |
$652.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,015.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.40
|
| Rate for Payer: EPIC Health Plan Senior |
$580.40
|
| Rate for Payer: Galaxy Health WC |
$1,233.35
|
| Rate for Payer: Global Benefits Group Commercial |
$870.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$921.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$856.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.24
|
| Rate for Payer: Multiplan Commercial |
$1,160.80
|
| Rate for Payer: Networks By Design Commercial |
$943.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,233.35
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,029.35 |
| Rate for Payer: Adventist Health Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$847.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.40
|
| Rate for Payer: EPIC Health Plan Senior |
$484.40
|
| Rate for Payer: Galaxy Health WC |
$1,029.35
|
| Rate for Payer: Global Benefits Group Commercial |
$726.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$768.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$714.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.64
|
| Rate for Payer: Multiplan Commercial |
$968.80
|
| Rate for Payer: Networks By Design Commercial |
$787.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,029.35
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$1,029.35 |
| Rate for Payer: Adventist Health Commercial |
$242.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$192.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.44
|
| Rate for Payer: Blue Shield of California Commercial |
$509.83
|
| Rate for Payer: Blue Shield of California Commercial |
$772.62
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cigna of CA HMO |
$775.04
|
| Rate for Payer: Cigna of CA PPO |
$896.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$847.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$1,029.35
|
| Rate for Payer: Global Benefits Group Commercial |
$726.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$768.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$968.80
|
| Rate for Payer: Networks By Design Commercial |
$787.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,029.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$726.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$726.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
915350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.76
|
| Rate for Payer: Blue Shield of California Commercial |
$399.88
|
| Rate for Payer: Blue Shield of California Commercial |
$263.64
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$348.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
915350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.76
|
| Rate for Payer: Blue Shield of California Commercial |
$399.88
|
| Rate for Payer: Blue Shield of California Commercial |
$263.64
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$348.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
