|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
OP
|
$6,289.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,257.80 |
| Max. Negotiated Rate |
$12,404.37 |
| Rate for Payer: Adventist Health Commercial |
$1,257.80
|
| 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 |
$3,458.95
|
| Rate for Payer: Cash Price |
$3,458.95
|
| Rate for Payer: Cash Price |
$3,458.95
|
| Rate for Payer: Cigna of CA HMO |
$4,024.96
|
| Rate for Payer: Cigna of CA PPO |
$4,653.86
|
| 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 |
$5,345.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,773.40
|
| 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 |
$4,194.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,509.36
|
| 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 |
$5,031.20
|
| Rate for Payer: Networks By Design Commercial |
$4,087.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,345.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,773.40
|
| 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
|
$2,437.00
|
|
|
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 |
$487.40
|
| 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 |
$1,340.35
|
| Rate for Payer: Cash Price |
$1,340.35
|
| Rate for Payer: Cash Price |
$1,340.35
|
| Rate for Payer: Cigna of CA HMO |
$1,559.68
|
| Rate for Payer: Cigna of CA PPO |
$1,803.38
|
| 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 |
$2,071.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,462.20
|
| 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 |
$1,625.48
|
| 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 |
$584.88
|
| 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 |
$1,949.60
|
| Rate for Payer: Networks By Design Commercial |
$1,584.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,071.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,462.20
|
| 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 |
$1,340.35
|
| 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 |
$1,092.30
|
| 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 |
$1,092.30
|
| Rate for Payer: Cash Price |
$1,092.30
|
| Rate for Payer: Cash Price |
$1,092.30
|
| 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
|
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 |
$2,268.75
|
| 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 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 |
$2,268.75
|
| 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 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 |
$1,120.35
|
| 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 |
$1,120.35
|
| Rate for Payer: Cash Price |
$1,120.35
|
| Rate for Payer: Cash Price |
$1,120.35
|
| 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
|
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 |
$1,217.15
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Cash Price |
$1,217.15
|
| 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 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 |
$1,217.15
|
| 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 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 |
$975.15
|
| 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 - 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 |
$975.15
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cash Price |
$975.15
|
| 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 2.6-7.5 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 |
$944.90
|
| 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 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 |
$944.90
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cash Price |
$944.90
|
| 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 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 |
$1,140.15
|
| Rate for Payer: Cash Price |
$1,140.15
|
| Rate for Payer: Cash Price |
$1,140.15
|
| 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 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 |
$1,140.15
|
| 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 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 |
$1,017.50
|
| Rate for Payer: Cash Price |
$1,017.50
|
| Rate for Payer: Cash Price |
$1,017.50
|
| 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
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$370.00 |
| Max. Negotiated Rate |
$1,572.50 |
| Rate for Payer: Adventist Health Commercial |
$370.00
|
| Rate for Payer: Cash Price |
$1,017.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$740.00
|
| Rate for Payer: Galaxy Health WC |
$1,572.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,233.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$704.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$1,480.00
|
| Rate for Payer: Networks By Design Commercial |
$1,202.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,572.50
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
OP
|
$2,278.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.47 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$455.60
|
| 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 |
$1,252.90
|
| Rate for Payer: Cash Price |
$1,252.90
|
| Rate for Payer: Cash Price |
$1,252.90
|
| Rate for Payer: Cigna of CA HMO |
$1,457.92
|
| Rate for Payer: Cigna of CA PPO |
$1,685.72
|
| 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 |
$1,936.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.80
|
| 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 |
$1,519.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.72
|
| 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 |
$1,822.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,480.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.30
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,366.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,139.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,139.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,139.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,139.00
|
| 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 7.6-12.5CM FACE
|
Facility
|
IP
|
$2,278.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$455.60 |
| Max. Negotiated Rate |
$1,936.30 |
| Rate for Payer: Adventist Health Commercial |
$455.60
|
| Rate for Payer: Cash Price |
$1,252.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.20
|
| Rate for Payer: EPIC Health Plan Senior |
$911.20
|
| Rate for Payer: Galaxy Health WC |
$1,936.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,519.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,410.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.72
|
| Rate for Payer: Multiplan Commercial |
$1,822.40
|
| Rate for Payer: Networks By Design Commercial |
$1,480.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.30
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
OP
|
$3,686.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.47 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$737.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$2,027.30
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cigna of CA HMO |
$2,359.04
|
| Rate for Payer: Cigna of CA PPO |
$2,727.64
|
| 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 |
$3,133.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,211.60
|
| 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 |
$2,458.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.64
|
| 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 |
$2,948.80
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$2,395.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,133.10
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,211.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,843.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,843.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,843.00
|
| 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 GT 30.0CM
|
Facility
|
IP
|
$3,686.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.20 |
| Max. Negotiated Rate |
$3,133.10 |
| Rate for Payer: Adventist Health Commercial |
$737.20
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,474.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,474.40
|
| Rate for Payer: Galaxy Health WC |
$3,133.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,211.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,458.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,404.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,281.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.64
|
| Rate for Payer: Multiplan Commercial |
$2,948.80
|
| Rate for Payer: Networks By Design Commercial |
$2,395.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,133.10
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.98 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$332.80
|
| 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 |
$915.20
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cigna of CA HMO |
$1,064.96
|
| Rate for Payer: Cigna of CA PPO |
$1,231.36
|
| 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 |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| 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 |
$1,109.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| 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 |
$1,331.20
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.00
|
| Rate for Payer: United Healthcare All Other HMO |
$832.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$832.00
|
| 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 LT 2.5 CM
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$1,414.40 |
| Rate for Payer: Adventist Health Commercial |
$332.80
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.60
|
| Rate for Payer: EPIC Health Plan Senior |
$665.60
|
| Rate for Payer: Galaxy Health WC |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,109.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,030.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
|
