|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$1,703.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.98 |
| 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 |
$1,021.80
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cigna of CA PPO |
$1,260.22
|
| 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 |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,277.25
|
| 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 |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.72
|
| 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 |
$1,362.40
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,021.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.50
|
| Rate for Payer: United Healthcare All Other HMO |
$851.50
|
| Rate for Payer: United Healthcare HMO Rider |
$851.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.50
|
| 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 LT 2.5 CM
|
Facility
|
IP
|
$1,703.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.72 |
| Max. Negotiated Rate |
$1,447.55 |
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.20
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.72
|
| Rate for Payer: Multiplan Commercial |
$1,362.40
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
OP
|
$1,696.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| 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 |
$1,017.60
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| 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 |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,272.00
|
| 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 |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.04
|
| 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 |
$1,356.80
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| 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 LT 2.5CM FACE
|
Facility
|
IP
|
$1,696.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$407.04 |
| Max. Negotiated Rate |
$1,441.60 |
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.04
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
IP
|
$2,866.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$687.84 |
| Max. Negotiated Rate |
$2,436.10 |
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,146.40
|
| Rate for Payer: Galaxy Health WC |
$2,436.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,719.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,911.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,091.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.84
|
| Rate for Payer: Multiplan Commercial |
$2,292.80
|
| Rate for Payer: Networks By Design Commercial |
$1,862.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,436.10
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
OP
|
$2,866.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
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 |
$1,719.60
|
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Cigna of CA PPO |
$2,120.84
|
| 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 |
$2,436.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,719.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,149.50
|
| 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 |
$1,911.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.84
|
| 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 |
$2,292.80
|
| Rate for Payer: Networks By Design Commercial |
$1,862.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,436.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,719.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,433.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,433.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,433.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,433.00
|
| 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 SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
IP
|
$3,116.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$747.84 |
| Max. Negotiated Rate |
$2,648.60 |
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.40
|
| Rate for Payer: Galaxy Health WC |
$2,648.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,869.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,078.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.84
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: Networks By Design Commercial |
$2,025.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,648.60
|
|
|
HC SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
OP
|
$3,116.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.38 |
| 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 |
$1,869.60
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cigna of CA PPO |
$2,305.84
|
| 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 |
$2,648.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,869.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,337.00
|
| 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 |
$2,078.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.84
|
| 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 |
$2,492.80
|
| Rate for Payer: Networks By Design Commercial |
$2,025.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,648.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,869.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,558.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,558.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,558.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,558.00
|
| 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 SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
IP
|
$3,428.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$822.72 |
| Max. Negotiated Rate |
$2,913.80 |
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,371.20
|
| Rate for Payer: Galaxy Health WC |
$2,913.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,056.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,286.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,306.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.72
|
| Rate for Payer: Multiplan Commercial |
$2,742.40
|
| Rate for Payer: Networks By Design Commercial |
$2,228.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,913.80
|
|
|
HC SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
OP
|
$3,428.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$498.20 |
| 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 |
$2,056.80
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cigna of CA PPO |
$2,536.72
|
| 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 |
$2,913.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,056.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,571.00
|
| 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 |
$2,286.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$618.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.72
|
| 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 |
$2,742.40
|
| Rate for Payer: Networks By Design Commercial |
$2,228.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,913.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,056.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,714.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,714.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,714.00
|
| 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 SIMULATION 3D COMPUTER
|
Facility
|
IP
|
$16,891.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$4,053.84 |
| Max. Negotiated Rate |
$14,357.35 |
| Rate for Payer: Cash Price |
$7,600.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,756.40
|
| Rate for Payer: Galaxy Health WC |
$14,357.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,134.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,266.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,435.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,053.84
|
| Rate for Payer: Multiplan Commercial |
$13,512.80
|
| Rate for Payer: Networks By Design Commercial |
$10,979.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,357.35
|
|
|
HC SIMULATION 3D COMPUTER
|
Facility
|
OP
|
$16,891.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$816.52 |
| Max. Negotiated Rate |
$14,357.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,131.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,731.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,368.56
|
| Rate for Payer: Blue Distinction Transplant |
$10,134.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9,982.58
|
| Rate for Payer: Blue Shield of California EPN |
$7,921.88
|
| Rate for Payer: Cash Price |
$7,600.95
|
| Rate for Payer: Cash Price |
$7,600.95
|
| Rate for Payer: Cash Price |
$7,600.95
|
| Rate for Payer: Cigna of CA HMO |
$10,810.24
|
| Rate for Payer: Cigna of CA PPO |
$12,499.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Dignity Health Media |
$1,731.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,904.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,337.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,731.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,731.24
|
| Rate for Payer: Galaxy Health WC |
$14,357.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,134.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,668.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,839.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,839.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,804.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,804.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,731.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,266.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,731.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,053.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,181.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,319.86
|
| Rate for Payer: Multiplan Commercial |
$13,512.80
|
| Rate for Payer: Networks By Design Commercial |
$10,979.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,357.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,134.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,731.24
|
|
|
HC SIMULATION COMPLEX
|
Facility
|
IP
|
$4,183.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,003.92 |
| Max. Negotiated Rate |
$3,555.55 |
| Rate for Payer: Cash Price |
$1,882.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,673.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,673.20
|
| Rate for Payer: Galaxy Health WC |
$3,555.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,509.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,790.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,593.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.92
|
| Rate for Payer: Multiplan Commercial |
$3,346.40
|
| Rate for Payer: Networks By Design Commercial |
$2,718.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,555.55
|
|
|
HC SIMULATION COMPLEX
|
Facility
|
OP
|
$4,183.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$296.19 |
| Max. Negotiated Rate |
$3,555.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,877.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,476.02
|
| Rate for Payer: Blue Distinction Transplant |
$2,509.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,961.83
|
| Rate for Payer: Cash Price |
$1,882.35
|
| Rate for Payer: Cash Price |
$1,882.35
|
| Rate for Payer: Cash Price |
$1,882.35
|
| Rate for Payer: Cigna of CA HMO |
$2,677.12
|
| Rate for Payer: Cigna of CA PPO |
$3,095.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$3,555.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,509.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,137.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,790.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,346.40
|
| Rate for Payer: Networks By Design Commercial |
$2,718.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,555.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,509.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC SIMULATION INTER
|
Facility
|
OP
|
$1,553.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$241.34 |
| Max. Negotiated Rate |
$1,773.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,773.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,268.34
|
| Rate for Payer: Blue Distinction Transplant |
$931.80
|
| Rate for Payer: Blue Shield of California Commercial |
$917.82
|
| Rate for Payer: Blue Shield of California EPN |
$728.36
|
| Rate for Payer: Cash Price |
$698.85
|
| Rate for Payer: Cash Price |
$698.85
|
| Rate for Payer: Cash Price |
$698.85
|
| Rate for Payer: Cigna of CA HMO |
$993.92
|
| Rate for Payer: Cigna of CA PPO |
$1,149.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$1,320.05
|
| Rate for Payer: Global Benefits Group Commercial |
$931.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,164.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,009.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,320.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$931.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC SIMULATION INTER
|
Facility
|
IP
|
$1,553.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$372.72 |
| Max. Negotiated Rate |
$1,320.05 |
| Rate for Payer: Cash Price |
$698.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$621.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$621.20
|
| Rate for Payer: Galaxy Health WC |
$1,320.05
|
| Rate for Payer: Global Benefits Group Commercial |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.72
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,009.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,320.05
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
OP
|
$2,002.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$152.27 |
| Max. Negotiated Rate |
$1,701.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$979.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$789.67
|
| Rate for Payer: Blue Distinction Transplant |
$1,201.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,183.18
|
| Rate for Payer: Blue Shield of California EPN |
$938.94
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cigna of CA HMO |
$1,281.28
|
| Rate for Payer: Cigna of CA PPO |
$1,481.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,701.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,501.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$278.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,335.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: Networks By Design Commercial |
$1,301.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,701.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,201.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
IP
|
$2,002.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$1,701.70 |
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$800.80
|
| Rate for Payer: Galaxy Health WC |
$1,701.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,335.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.48
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: Networks By Design Commercial |
$1,301.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,701.70
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$192.96 |
| Max. Negotiated Rate |
$683.40 |
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.60
|
| Rate for Payer: Galaxy Health WC |
$683.40
|
| Rate for Payer: Global Benefits Group Commercial |
$482.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.96
|
| Rate for Payer: Multiplan Commercial |
$643.20
|
| Rate for Payer: Networks By Design Commercial |
$522.60
|
| Rate for Payer: Prime Health Services Commercial |
$683.40
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$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 Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$737.46
|
| Rate for Payer: Blue Distinction Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$261.63
|
| Rate for Payer: Blue Shield of California EPN |
$207.36
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Media |
$323.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$323.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$323.75
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$524.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$524.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$407.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| 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 HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| 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 Senior |
$323.75
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$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 Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$670.38
|
| Rate for Payer: Blue Distinction Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$261.63
|
| Rate for Payer: Blue Shield of California EPN |
$207.36
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Media |
$325.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$325.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$325.80
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$527.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$527.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| 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 HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| 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 Senior |
$325.80
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.96 |
| Max. Negotiated Rate |
$683.40 |
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.60
|
| Rate for Payer: Galaxy Health WC |
$683.40
|
| Rate for Payer: Global Benefits Group Commercial |
$482.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.96
|
| Rate for Payer: Multiplan Commercial |
$643.20
|
| Rate for Payer: Networks By Design Commercial |
$522.60
|
| Rate for Payer: Prime Health Services Commercial |
$683.40
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$1,312.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$226.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.07
|
| Rate for Payer: Blue Distinction Transplant |
$926.40
|
| Rate for Payer: Blue Shield of California Commercial |
$912.50
|
| Rate for Payer: Blue Shield of California EPN |
$724.14
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cigna of CA HMO |
$988.16
|
| Rate for Payer: Cigna of CA PPO |
$1,142.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$1,312.40
|
| Rate for Payer: Global Benefits Group Commercial |
$926.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,158.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,029.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: Networks By Design Commercial |
$1,003.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,312.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$926.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$926.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$370.56 |
| Max. Negotiated Rate |
$1,312.40 |
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.60
|
| Rate for Payer: Galaxy Health WC |
$1,312.40
|
| Rate for Payer: Global Benefits Group Commercial |
$926.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,029.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.56
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: Networks By Design Commercial |
$1,003.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,312.40
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.00
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
|
