|
HC SIGMDSCPY W TUMOR SNARE RMVL
|
Facility
|
IP
|
$4,352.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
906745338
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,044.48 |
| Max. Negotiated Rate |
$3,699.20 |
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.80
|
| Rate for Payer: Galaxy Health WC |
$3,699.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,902.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.48
|
| Rate for Payer: Multiplan Commercial |
$3,481.60
|
| Rate for Payer: Networks By Design Commercial |
$2,828.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.20
|
|
|
HC SIGMOIDOSCOPY W ENDO MCSL RESC
|
Facility
|
OP
|
$2,606.00
|
|
|
Service Code
|
CPT 45349
|
| Hospital Charge Code |
906745349
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$625.44 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,563.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,172.70
|
| Rate for Payer: Cash Price |
$1,172.70
|
| Rate for Payer: Cigna of CA PPO |
$1,928.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Media |
$3,508.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,736.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,508.15
|
| Rate for Payer: Galaxy Health WC |
$2,215.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,563.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,954.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,753.37
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,753.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,683.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5,683.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,738.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,508.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,700.92
|
| Rate for Payer: Multiplan Commercial |
$2,084.80
|
| Rate for Payer: Networks By Design Commercial |
$1,693.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,215.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,563.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,209.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC SIGMOIDOSCOPY W ENDO MCSL RESC
|
Facility
|
IP
|
$2,606.00
|
|
|
Service Code
|
CPT 45349
|
| Hospital Charge Code |
906745349
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$625.44 |
| Max. Negotiated Rate |
$2,215.10 |
| Rate for Payer: Cash Price |
$1,172.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,042.40
|
| Rate for Payer: Galaxy Health WC |
$2,215.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,563.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,738.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$992.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.44
|
| Rate for Payer: Multiplan Commercial |
$2,084.80
|
| Rate for Payer: Networks By Design Commercial |
$1,693.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,215.10
|
|
|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
IP
|
$7,789.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,869.36 |
| Max. Negotiated Rate |
$6,620.65 |
| Rate for Payer: Cash Price |
$3,505.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.60
|
| Rate for Payer: Galaxy Health WC |
$6,620.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,673.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,195.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,967.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.36
|
| Rate for Payer: Multiplan Commercial |
$6,231.20
|
| Rate for Payer: Networks By Design Commercial |
$5,062.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,620.65
|
|
|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
OP
|
$5,205.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,249.20 |
| Max. Negotiated Rate |
$11,678.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,123.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,342.25
|
| Rate for Payer: Cash Price |
$2,342.25
|
| Rate for Payer: Cigna of CA PPO |
$3,851.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Media |
$7,120.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,613.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,120.83
|
| Rate for Payer: Galaxy Health WC |
$4,424.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,123.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,903.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,678.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,678.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,535.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,535.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,471.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.91
|
| Rate for Payer: Multiplan Commercial |
$4,164.00
|
| Rate for Payer: Networks By Design Commercial |
$3,383.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,424.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$291.67 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$979.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Cigna of CA PPO |
$1,208.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$1,388.05
|
| Rate for Payer: Global Benefits Group Commercial |
$979.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,224.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,872.77
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,872.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,849.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,849.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,089.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$1,306.40
|
| Rate for Payer: Networks By Design Commercial |
$1,061.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,370.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
IP
|
$3,018.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$724.32 |
| Max. Negotiated Rate |
$2,565.30 |
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,207.20
|
| Rate for Payer: Galaxy Health WC |
$2,565.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,810.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,013.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,149.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.32
|
| Rate for Payer: Multiplan Commercial |
$2,414.40
|
| Rate for Payer: Networks By Design Commercial |
$1,961.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,565.30
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$590.16 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,475.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: Cigna of CA PPO |
$1,819.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Media |
$1,474.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$2,090.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,475.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,844.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,418.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,418.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,388.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,388.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,640.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$1,967.20
|
| Rate for Payer: Networks By Design Commercial |
$1,598.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,090.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,475.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$590.16 |
| Max. Negotiated Rate |
$2,090.15 |
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.60
|
| Rate for Payer: Galaxy Health WC |
$2,090.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,475.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,640.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.16
|
| Rate for Payer: Multiplan Commercial |
$1,967.20
|
| Rate for Payer: Networks By Design Commercial |
$1,598.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,090.15
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$1,772.25 |
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$834.00
|
| Rate for Payer: Galaxy Health WC |
$1,772.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,251.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.40
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,355.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,772.25
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,251.00
|
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Cigna of CA PPO |
$1,542.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,772.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,251.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,563.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,355.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,772.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,251.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,042.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,042.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
OP
|
$2,604.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna of CA PPO |
$1,926.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,213.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,562.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,953.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,736.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$2,083.20
|
| Rate for Payer: Networks By Design Commercial |
$1,692.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,213.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,562.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,302.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,302.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,302.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
IP
|
$2,604.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$624.96 |
| Max. Negotiated Rate |
$2,213.40 |
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,041.60
|
| Rate for Payer: Galaxy Health WC |
$2,213.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,562.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,736.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$992.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.96
|
| Rate for Payer: Multiplan Commercial |
$2,083.20
|
| Rate for Payer: Networks By Design Commercial |
$1,692.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,213.40
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
IP
|
$1,814.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.36 |
| Max. Negotiated Rate |
$1,541.90 |
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$725.60
|
| Rate for Payer: Galaxy Health WC |
$1,541.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,088.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,209.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.36
|
| Rate for Payer: Multiplan Commercial |
$1,451.20
|
| Rate for Payer: Networks By Design Commercial |
$1,179.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,541.90
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
OP
|
$1,814.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.16 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,088.40
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cigna of CA PPO |
$1,342.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,541.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,088.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,360.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,209.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,451.20
|
| Rate for Payer: Networks By Design Commercial |
$1,179.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,541.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,088.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.00
|
| Rate for Payer: United Healthcare All Other HMO |
$907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$907.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
IP
|
$1,758.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.92 |
| Max. Negotiated Rate |
$1,494.30 |
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.20
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.92
|
| Rate for Payer: Multiplan Commercial |
$1,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
OP
|
$1,758.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.98 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,054.80
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna of CA PPO |
$1,300.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,318.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,054.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$879.00
|
| Rate for Payer: United Healthcare All Other HMO |
$879.00
|
| Rate for Payer: United Healthcare HMO Rider |
$879.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$879.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,272.60
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cigna of CA PPO |
$1,569.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,802.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,590.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: Networks By Design Commercial |
$1,378.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,060.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,060.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.04 |
| Max. Negotiated Rate |
$1,802.85 |
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.40
|
| Rate for Payer: Galaxy Health WC |
$1,802.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.04
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: Networks By Design Commercial |
$1,378.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.85
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,135.80
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cigna of CA PPO |
$1,400.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,609.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,135.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,419.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,262.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,514.40
|
| Rate for Payer: Networks By Design Commercial |
$1,230.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,135.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$946.50
|
| Rate for Payer: United Healthcare All Other HMO |
$946.50
|
| Rate for Payer: United Healthcare HMO Rider |
$946.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$946.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$454.32 |
| Max. Negotiated Rate |
$1,609.05 |
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.20
|
| Rate for Payer: Galaxy Health WC |
$1,609.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,135.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,262.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.32
|
| Rate for Payer: Multiplan Commercial |
$1,514.40
|
| Rate for Payer: Networks By Design Commercial |
$1,230.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.05
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
OP
|
$2,331.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,398.60
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Cigna of CA PPO |
$1,724.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,981.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,748.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,864.80
|
| Rate for Payer: Networks By Design Commercial |
$1,515.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,981.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,398.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,165.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,165.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,165.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,165.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
IP
|
$2,331.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$559.44 |
| Max. Negotiated Rate |
$1,981.35 |
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$932.40
|
| Rate for Payer: Galaxy Health WC |
$1,981.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.44
|
| Rate for Payer: Multiplan Commercial |
$1,864.80
|
| Rate for Payer: Networks By Design Commercial |
$1,515.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,981.35
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
IP
|
$3,771.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$905.04 |
| Max. Negotiated Rate |
$3,205.35 |
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.40
|
| Rate for Payer: Galaxy Health WC |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,436.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.04
|
| Rate for Payer: Multiplan Commercial |
$3,016.80
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
OP
|
$3,771.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,262.60
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cigna of CA PPO |
$2,790.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,828.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$3,016.80
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,262.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
