|
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 |
$832.50
|
| 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 |
$1,025.10
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cash Price |
$1,025.10
|
| 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 |
$1,025.10
|
| 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 |
$1,658.70
|
| Rate for Payer: Cash Price |
$1,658.70
|
| Rate for Payer: Cash Price |
$1,658.70
|
| 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 |
$1,658.70
|
| 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
|
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 |
$748.80
|
| 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
|
|
|
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 |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| 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 2.5CM FACE
|
Facility
|
OP
|
$1,658.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$331.60
|
| 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 |
$746.10
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cigna of CA HMO |
$1,061.12
|
| Rate for Payer: Cigna of CA PPO |
$1,226.92
|
| 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 |
$1,409.30
|
| Rate for Payer: Global Benefits Group Commercial |
$994.80
|
| 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 |
$1,105.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.92
|
| 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 |
$1,326.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,077.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,409.30
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$994.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.00
|
| Rate for Payer: United Healthcare All Other HMO |
$829.00
|
| Rate for Payer: United Healthcare HMO Rider |
$829.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$829.00
|
| 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 2.5CM FACE
|
Facility
|
IP
|
$1,658.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.60 |
| Max. Negotiated Rate |
$1,409.30 |
| Rate for Payer: Adventist Health Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$663.20
|
| Rate for Payer: EPIC Health Plan Senior |
$663.20
|
| Rate for Payer: Galaxy Health WC |
$1,409.30
|
| Rate for Payer: Global Benefits Group Commercial |
$994.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,026.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.92
|
| Rate for Payer: Multiplan Commercial |
$1,326.40
|
| Rate for Payer: Networks By Design Commercial |
$1,077.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,409.30
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
IP
|
$2,801.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.20 |
| Max. Negotiated Rate |
$2,380.85 |
| Rate for Payer: Adventist Health Commercial |
$560.20
|
| Rate for Payer: Cash Price |
$1,260.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,120.40
|
| Rate for Payer: Galaxy Health WC |
$2,380.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,680.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,868.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,067.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,733.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.24
|
| Rate for Payer: Multiplan Commercial |
$2,240.80
|
| Rate for Payer: Networks By Design Commercial |
$1,820.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,380.85
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
OP
|
$2,801.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.47 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$560.20
|
| 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 |
$1,260.45
|
| Rate for Payer: Cash Price |
$1,260.45
|
| Rate for Payer: Cash Price |
$1,260.45
|
| Rate for Payer: Cigna of CA HMO |
$1,792.64
|
| Rate for Payer: Cigna of CA PPO |
$2,072.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$2,380.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,680.60
|
| 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 |
$1,868.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.24
|
| 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 |
$2,240.80
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,820.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,380.85
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,680.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,400.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,400.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,400.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,400.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
IP
|
$2,649.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$529.80 |
| Max. Negotiated Rate |
$2,251.65 |
| Rate for Payer: Adventist Health Commercial |
$529.80
|
| Rate for Payer: Cash Price |
$1,192.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,059.60
|
| Rate for Payer: Galaxy Health WC |
$2,251.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,589.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,766.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,009.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,639.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.76
|
| Rate for Payer: Multiplan Commercial |
$2,119.20
|
| Rate for Payer: Networks By Design Commercial |
$1,721.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,251.65
|
|
|
HC SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
OP
|
$2,649.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$529.80
|
| 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 |
$1,192.05
|
| Rate for Payer: Cash Price |
$1,192.05
|
| Rate for Payer: Cash Price |
$1,192.05
|
| Rate for Payer: Cigna of CA HMO |
$1,695.36
|
| Rate for Payer: Cigna of CA PPO |
$1,960.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$2,251.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,589.40
|
| 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 |
$1,766.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.76
|
| 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 |
$2,119.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,721.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,251.65
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,589.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,324.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,324.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
OP
|
$3,351.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$507.64 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$670.20
|
| 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 |
$1,507.95
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: Cigna of CA HMO |
$2,144.64
|
| Rate for Payer: Cigna of CA PPO |
$2,479.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$2,848.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,010.60
|
| 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 |
$2,235.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$618.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.24
|
| 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 |
$2,680.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,178.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,848.35
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,010.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,675.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,675.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,675.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
IP
|
$3,351.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$670.20 |
| Max. Negotiated Rate |
$2,848.35 |
| Rate for Payer: Adventist Health Commercial |
$670.20
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,340.40
|
| Rate for Payer: Galaxy Health WC |
$2,848.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,010.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,235.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,276.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,074.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.24
|
| Rate for Payer: Multiplan Commercial |
$2,680.80
|
| Rate for Payer: Networks By Design Commercial |
$2,178.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,848.35
|
|
|
HC SIMULATION 3D COMPUTER
|
Facility
|
IP
|
$14,357.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,871.40 |
| Max. Negotiated Rate |
$12,203.45 |
| Rate for Payer: Adventist Health Commercial |
$2,871.40
|
| Rate for Payer: Cash Price |
$6,460.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,742.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,742.80
|
| Rate for Payer: Galaxy Health WC |
$12,203.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,614.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,576.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,470.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,886.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,445.68
|
| Rate for Payer: Multiplan Commercial |
$11,485.60
|
| Rate for Payer: Networks By Design Commercial |
$9,332.05
|
| Rate for Payer: Prime Health Services Commercial |
$12,203.45
|
|
|
HC SIMULATION 3D COMPUTER
|
Facility
|
OP
|
$14,357.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$721.98 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$2,871.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,416.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,738.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,894.54
|
| Rate for Payer: Blue Shield of California Commercial |
$8,786.48
|
| Rate for Payer: Blue Shield of California EPN |
$5,800.23
|
| Rate for Payer: Cash Price |
$6,460.65
|
| Rate for Payer: Cash Price |
$6,460.65
|
| Rate for Payer: Cash Price |
$6,460.65
|
| Rate for Payer: Cigna of CA HMO |
$9,188.48
|
| Rate for Payer: Cigna of CA PPO |
$10,624.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,912.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,738.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,346.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.51
|
| Rate for Payer: Galaxy Health WC |
$12,203.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,614.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,851.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$721.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,738.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,576.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,445.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,190.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,329.60
|
| Rate for Payer: Multiplan Commercial |
$11,485.60
|
| Rate for Payer: Networks By Design Commercial |
$9,332.05
|
| Rate for Payer: Prime Health Services Commercial |
$12,203.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,614.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,738.51
|
|
|
HC SIMULATION COMPLEX
|
Facility
|
IP
|
$3,556.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$711.20 |
| Max. Negotiated Rate |
$3,022.60 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,422.40
|
| Rate for Payer: Galaxy Health WC |
$3,022.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,133.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,371.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,354.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,201.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.44
|
| Rate for Payer: Multiplan Commercial |
$2,844.80
|
| Rate for Payer: Networks By Design Commercial |
$2,311.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,022.60
|
|
|
HC SIMULATION COMPLEX
|
Facility
|
OP
|
$3,556.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$261.90 |
| Max. Negotiated Rate |
$3,022.60 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,332.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,597.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,176.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,436.62
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cigna of CA HMO |
$2,275.84
|
| Rate for Payer: Cigna of CA PPO |
$2,631.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$3,022.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,133.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$261.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,371.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$2,844.80
|
| Rate for Payer: Networks By Design Commercial |
$2,311.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,022.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,133.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC SIMULATION INTER
|
Facility
|
IP
|
$1,254.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Adventist Health Commercial |
$250.80
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$501.60
|
| Rate for Payer: Galaxy Health WC |
$1,065.90
|
| Rate for Payer: Global Benefits Group Commercial |
$752.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$836.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$776.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.96
|
| Rate for Payer: Multiplan Commercial |
$1,003.20
|
| Rate for Payer: Networks By Design Commercial |
$815.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.90
|
|
|
HC SIMULATION INTER
|
Facility
|
OP
|
$1,254.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$213.39 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$250.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$822.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,373.10
|
| Rate for Payer: Blue Shield of California Commercial |
$767.45
|
| Rate for Payer: Blue Shield of California EPN |
$506.62
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Cigna of CA HMO |
$802.56
|
| Rate for Payer: Cigna of CA PPO |
$927.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$1,065.90
|
| Rate for Payer: Global Benefits Group Commercial |
$752.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$836.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$1,003.20
|
| Rate for Payer: Networks By Design Commercial |
$815.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$752.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
IP
|
$1,702.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$340.40 |
| Max. Negotiated Rate |
$1,446.70 |
| Rate for Payer: Adventist Health Commercial |
$340.40
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$680.80
|
| Rate for Payer: EPIC Health Plan Senior |
$680.80
|
| Rate for Payer: Galaxy Health WC |
$1,446.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,053.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.48
|
| Rate for Payer: Multiplan Commercial |
$1,361.60
|
| Rate for Payer: Networks By Design Commercial |
$1,106.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,446.70
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
OP
|
$1,702.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$340.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,116.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$854.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,041.62
|
| Rate for Payer: Blue Shield of California EPN |
$687.61
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna of CA HMO |
$1,089.28
|
| Rate for Payer: Cigna of CA PPO |
$1,259.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| Rate for Payer: Galaxy Health WC |
$1,446.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| Rate for Payer: Multiplan Commercial |
$1,361.60
|
| Rate for Payer: Networks By Design Commercial |
$1,106.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,446.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,021.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$168.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Adventist Health Commercial |
$212.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.60
|
| Rate for Payer: EPIC Health Plan Senior |
$425.60
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.36
|
| Rate for Payer: Multiplan Commercial |
$851.20
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$798.36 |
| Rate for Payer: Adventist Health Commercial |
$173.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$567.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$798.36
|
| Rate for Payer: Blue Shield of California Commercial |
$578.68
|
| Rate for Payer: Blue Shield of California EPN |
$382.33
|
| Rate for Payer: Cash Price |
$389.25
|
| Rate for Payer: Cash Price |
$389.25
|
| Rate for Payer: Cigna of CA HMO |
$553.60
|
| Rate for Payer: Cigna of CA PPO |
$640.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.06
|
| Rate for Payer: EPIC Health Plan Senior |
$323.75
|
| Rate for Payer: Galaxy Health WC |
$735.25
|
| Rate for Payer: Global Benefits Group Commercial |
$519.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$407.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$692.00
|
| Rate for Payer: Networks By Design Commercial |
$562.25
|
| Rate for Payer: Prime Health Services Commercial |
$735.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$519.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$519.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
