|
HC SIGMDSCPY W TUMOR ABLATION
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 45346
|
| Hospital Charge Code |
906745346
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$450.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cigna of CA HMO |
$1,440.00
|
| Rate for Payer: Cigna of CA PPO |
$1,665.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$1,912.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,500.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,912.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,350.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC SIGMDSCPY W TUMOR SNARE RMVL
|
Facility
|
OP
|
$2,473.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
906745338
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$240.81 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$494.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,112.85
|
| Rate for Payer: Cash Price |
$1,112.85
|
| Rate for Payer: Cash Price |
$1,112.85
|
| Rate for Payer: Cigna of CA HMO |
$1,582.72
|
| Rate for Payer: Cigna of CA PPO |
$1,830.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$2,102.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,483.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$240.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,649.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: Networks By Design Commercial |
$1,607.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,102.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,483.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC SIGMDSCPY W TUMOR SNARE RMVL
|
Facility
|
IP
|
$3,514.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
906745338
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$702.80 |
| Max. Negotiated Rate |
$2,986.90 |
| Rate for Payer: Adventist Health Commercial |
$702.80
|
| Rate for Payer: Cash Price |
$1,581.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,405.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,405.60
|
| Rate for Payer: Galaxy Health WC |
$2,986.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,108.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,343.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,338.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,175.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.36
|
| Rate for Payer: Multiplan Commercial |
$2,811.20
|
| Rate for Payer: Networks By Design Commercial |
$2,284.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,986.90
|
|
|
HC SIGMOIDOSCOPY W ENDO MCSL RESC
|
Facility
|
OP
|
$2,104.00
|
|
|
Service Code
|
CPT 45349
|
| Hospital Charge Code |
906745349
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$420.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$420.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cigna of CA HMO |
$1,346.56
|
| Rate for Payer: Cigna of CA PPO |
$1,556.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,704.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.48
|
| Rate for Payer: Galaxy Health WC |
$1,788.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,262.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,714.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,669.20
|
| Rate for Payer: Multiplan Commercial |
$1,683.20
|
| Rate for Payer: Networks By Design Commercial |
$1,367.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,788.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,262.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,181.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,484.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC SIGMOIDOSCOPY W ENDO MCSL RESC
|
Facility
|
IP
|
$2,104.00
|
|
|
Service Code
|
CPT 45349
|
| Hospital Charge Code |
906745349
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$420.80 |
| Max. Negotiated Rate |
$1,788.40 |
| Rate for Payer: Adventist Health Commercial |
$420.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$841.60
|
| Rate for Payer: EPIC Health Plan Senior |
$841.60
|
| Rate for Payer: Galaxy Health WC |
$1,788.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,262.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,302.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.96
|
| Rate for Payer: Multiplan Commercial |
$1,683.20
|
| Rate for Payer: Networks By Design Commercial |
$1,367.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,788.40
|
|
|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
IP
|
$6,289.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,257.80 |
| Max. Negotiated Rate |
$5,345.65 |
| Rate for Payer: Adventist Health Commercial |
$1,257.80
|
| Rate for Payer: Cash Price |
$2,830.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,515.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,515.60
|
| Rate for Payer: Galaxy Health WC |
$5,345.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,773.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,396.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,892.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,509.36
|
| Rate for Payer: Multiplan Commercial |
$5,031.20
|
| Rate for Payer: Networks By Design Commercial |
$4,087.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,345.65
|
|
|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
OP
|
$4,411.00
|
|
|
Service Code
|
CPT 45345
|
| Hospital Charge Code |
906745345
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$882.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$882.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,426.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,308.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,708.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,984.95
|
| Rate for Payer: Cash Price |
$1,984.95
|
| Rate for Payer: Cigna of CA HMO |
$2,823.04
|
| Rate for Payer: Cigna of CA PPO |
$3,264.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,749.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,764.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,764.40
|
| Rate for Payer: Galaxy Health WC |
$3,749.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,646.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,942.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,680.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,730.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,087.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,087.70
|
| Rate for Payer: Multiplan Commercial |
$3,528.80
|
| Rate for Payer: Networks By Design Commercial |
$2,867.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,749.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,646.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,646.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,205.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,205.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,205.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,205.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,749.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,749.35
|
|
|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
OP
|
$4,424.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$884.80 |
| Max. Negotiated Rate |
$12,404.37 |
| Rate for Payer: Adventist Health Commercial |
$884.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna of CA HMO |
$2,831.36
|
| Rate for Payer: Cigna of CA PPO |
$3,273.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Galaxy Health WC |
$3,760.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,654.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,950.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$3,539.20
|
| Rate for Payer: Networks By Design Commercial |
$2,875.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,760.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,654.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$257.70 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$277.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna of CA HMO |
$888.32
|
| Rate for Payer: Cigna of CA PPO |
$1,027.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$257.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: Networks By Design Commercial |
$902.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$832.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
IP
|
$2,437.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$487.40 |
| Max. Negotiated Rate |
$2,071.45 |
| Rate for Payer: Adventist Health Commercial |
$487.40
|
| Rate for Payer: Cash Price |
$1,096.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.80
|
| Rate for Payer: EPIC Health Plan Senior |
$974.80
|
| Rate for Payer: Galaxy Health WC |
$2,071.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,462.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,625.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,508.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.88
|
| Rate for Payer: Multiplan Commercial |
$1,949.60
|
| Rate for Payer: Networks By Design Commercial |
$1,584.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,071.45
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
IP
|
$1,986.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$397.20 |
| Max. Negotiated Rate |
$1,688.10 |
| Rate for Payer: Adventist Health Commercial |
$397.20
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.40
|
| Rate for Payer: EPIC Health Plan Senior |
$794.40
|
| Rate for Payer: Galaxy Health WC |
$1,688.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,191.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,324.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$756.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,229.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.64
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: Networks By Design Commercial |
$1,290.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,688.10
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
OP
|
$1,986.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$397.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$397.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna of CA HMO |
$1,271.04
|
| Rate for Payer: Cigna of CA PPO |
$1,469.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$1,688.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,191.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,324.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: Networks By Design Commercial |
$1,290.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,688.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,191.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC SILVERHAWK THROMB CATH
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,506.25 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,705.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,268.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,533.16
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cigna of CA HMO |
$2,640.00
|
| Rate for Payer: Cigna of CA PPO |
$3,052.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,506.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,887.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,887.50
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,062.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,506.25
|
|
|
HC SILVERHAWK THROMB CATH
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,506.25 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
IP
|
$2,037.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$1,731.45 |
| Rate for Payer: Adventist Health Commercial |
$407.40
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.80
|
| Rate for Payer: EPIC Health Plan Senior |
$814.80
|
| Rate for Payer: Galaxy Health WC |
$1,731.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,222.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$776.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.88
|
| Rate for Payer: Multiplan Commercial |
$1,629.60
|
| Rate for Payer: Networks By Design Commercial |
$1,324.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,731.45
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
OP
|
$2,037.00
|
|
|
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: Adventist Health Commercial |
$407.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: Cigna of CA HMO |
$1,303.68
|
| Rate for Payer: Cigna of CA PPO |
$1,507.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,731.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,222.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,629.60
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,324.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,731.45
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,222.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,018.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,018.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,018.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,018.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$442.60 |
| Max. Negotiated Rate |
$1,881.05 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.20
|
| Rate for Payer: EPIC Health Plan Senior |
$885.20
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,476.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.12
|
| Rate for Payer: Multiplan Commercial |
$1,770.40
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.73 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cigna of CA HMO |
$1,416.32
|
| Rate for Payer: Cigna of CA PPO |
$1,637.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,476.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,770.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,327.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,106.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,106.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,106.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
OP
|
$1,773.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.16 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cigna of CA HMO |
$1,134.72
|
| Rate for Payer: Cigna of CA PPO |
$1,312.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,507.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,063.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,182.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,418.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,152.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,507.05
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,063.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$886.50
|
| Rate for Payer: United Healthcare All Other HMO |
$886.50
|
| Rate for Payer: United Healthcare HMO Rider |
$886.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$886.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
IP
|
$1,773.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$1,507.05 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$709.20
|
| Rate for Payer: EPIC Health Plan Senior |
$709.20
|
| Rate for Payer: Galaxy Health WC |
$1,507.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,063.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,182.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,097.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.52
|
| Rate for Payer: Multiplan Commercial |
$1,418.40
|
| Rate for Payer: Networks By Design Commercial |
$1,152.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,507.05
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
OP
|
$1,718.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.98 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna of CA HMO |
$1,099.52
|
| Rate for Payer: Cigna of CA PPO |
$1,271.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,460.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,374.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,116.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,460.30
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$859.00
|
| Rate for Payer: United Healthcare All Other HMO |
$859.00
|
| Rate for Payer: United Healthcare HMO Rider |
$859.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$859.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
IP
|
$1,718.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$1,460.30 |
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.20
|
| Rate for Payer: EPIC Health Plan Senior |
$687.20
|
| Rate for Payer: Galaxy Health WC |
$1,460.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,063.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.32
|
| Rate for Payer: Multiplan Commercial |
$1,374.40
|
| Rate for Payer: Networks By Design Commercial |
$1,116.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,460.30
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$414.60 |
| Max. Negotiated Rate |
$1,762.05 |
| Rate for Payer: Adventist Health Commercial |
$414.60
|
| Rate for Payer: Cash Price |
$932.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$829.20
|
| Rate for Payer: Galaxy Health WC |
$1,762.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,243.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,382.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,283.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.52
|
| Rate for Payer: Multiplan Commercial |
$1,658.40
|
| Rate for Payer: Networks By Design Commercial |
$1,347.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,762.05
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$414.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$932.85
|
| Rate for Payer: Cash Price |
$932.85
|
| Rate for Payer: Cash Price |
$932.85
|
| Rate for Payer: Cigna of CA HMO |
$1,326.72
|
| Rate for Payer: Cigna of CA PPO |
$1,534.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,762.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,243.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,382.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,658.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,347.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,762.05
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,243.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,036.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,036.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,036.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$370.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna of CA HMO |
$1,184.00
|
| Rate for Payer: Cigna of CA PPO |
$1,369.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,572.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,233.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,480.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,202.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,572.50
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$925.00
|
| Rate for Payer: United Healthcare All Other HMO |
$925.00
|
| Rate for Payer: United Healthcare HMO Rider |
$925.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
