|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,635.20
|
| Rate for Payer: Cigna of CA HMO |
$2,108.16
|
| Rate for Payer: Cigna of CA PPO |
$2,437.56
|
| 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 |
$2,799.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,976.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,964.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,197.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,470.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,141.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,799.90
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,976.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,976.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| 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 LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
IP
|
$2,280.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Adventist Health Commercial |
$456.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,824.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$912.00
|
| Rate for Payer: EPIC Health Plan Senior |
$912.00
|
| Rate for Payer: Galaxy Health WC |
$1,938.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,368.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,052.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$868.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,411.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.00
|
| Rate for Payer: Multiplan Commercial |
$1,710.00
|
| Rate for Payer: Networks By Design Commercial |
$1,482.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,938.00
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
IP
|
$2,280.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Adventist Health Commercial |
$456.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,824.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$912.00
|
| Rate for Payer: EPIC Health Plan Senior |
$912.00
|
| Rate for Payer: Galaxy Health WC |
$1,938.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,368.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,052.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$868.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,411.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.00
|
| Rate for Payer: Multiplan Commercial |
$1,710.00
|
| Rate for Payer: Networks By Design Commercial |
$1,482.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,938.00
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
OP
|
$2,280.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.58 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$456.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,824.00
|
| Rate for Payer: Cigna of CA HMO |
$1,459.20
|
| Rate for Payer: Cigna of CA PPO |
$1,687.20
|
| 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 |
$1,938.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,368.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,052.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,710.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,482.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,938.00
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,140.00
|
| 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 LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
OP
|
$2,280.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$189.58 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$934.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,824.00
|
| Rate for Payer: Cigna of CA HMO |
$1,459.20
|
| Rate for Payer: Cigna of CA PPO |
$1,687.20
|
| 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 |
$1,938.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,368.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,052.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,710.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,482.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,938.00
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,368.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,368.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| 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 LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
IP
|
$3,458.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$3,112.20 |
| Rate for Payer: Adventist Health Commercial |
$691.60
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,766.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,383.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,383.20
|
| Rate for Payer: Galaxy Health WC |
$2,939.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,112.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,306.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,317.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,140.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.60
|
| Rate for Payer: Multiplan Commercial |
$2,593.50
|
| Rate for Payer: Networks By Design Commercial |
$2,247.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,939.30
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
OP
|
$3,458.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$3,112.20 |
| Rate for Payer: Adventist Health Commercial |
$691.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,766.40
|
| Rate for Payer: Cigna of CA HMO |
$2,213.12
|
| Rate for Payer: Cigna of CA PPO |
$2,558.92
|
| 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 |
$2,939.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,112.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,306.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,593.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,247.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,939.30
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,074.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,729.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,729.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,729.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,729.00
|
| 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 LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
IP
|
$3,458.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$3,112.20 |
| Rate for Payer: Adventist Health Commercial |
$691.60
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,766.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,383.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,383.20
|
| Rate for Payer: Galaxy Health WC |
$2,939.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,112.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,306.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,317.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,140.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.60
|
| Rate for Payer: Multiplan Commercial |
$2,593.50
|
| Rate for Payer: Networks By Design Commercial |
$2,247.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,939.30
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
OP
|
$3,458.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,417.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,556.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,766.40
|
| Rate for Payer: Cigna of CA HMO |
$2,213.12
|
| Rate for Payer: Cigna of CA PPO |
$2,558.92
|
| 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 |
$2,939.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,074.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,112.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,306.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,593.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,247.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,939.30
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,074.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,074.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| 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 LAY CLOS OF WNDS GT 30.0 CM
|
Facility
|
IP
|
$4,544.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$908.80 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Adventist Health Commercial |
$908.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,635.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,817.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,817.60
|
| Rate for Payer: Galaxy Health WC |
$3,862.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,726.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,089.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,030.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,731.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,812.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.80
|
| Rate for Payer: Multiplan Commercial |
$3,408.00
|
| Rate for Payer: Networks By Design Commercial |
$2,953.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,862.40
|
|
|
HC LAY CLOS OF WNDS GT 30.0 CM
|
Facility
|
OP
|
$4,544.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$908.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,635.20
|
| Rate for Payer: Cigna of CA HMO |
$2,908.16
|
| Rate for Payer: Cigna of CA PPO |
$3,362.56
|
| 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 |
$3,862.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,726.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,089.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,030.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$3,408.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,953.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,862.40
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,726.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,272.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,272.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,272.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,272.00
|
| 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 LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$178.26 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$802.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,566.40
|
| Rate for Payer: Cigna of CA HMO |
$1,253.12
|
| Rate for Payer: Cigna of CA PPO |
$1,448.92
|
| 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 |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,762.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,468.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| 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 LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$1,762.20 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,566.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,762.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.60
|
| Rate for Payer: Multiplan Commercial |
$1,468.50
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$1,762.20 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,566.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,762.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.60
|
| Rate for Payer: Multiplan Commercial |
$1,468.50
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.26 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,566.40
|
| Rate for Payer: Cigna of CA HMO |
$1,253.12
|
| Rate for Payer: Cigna of CA PPO |
$1,448.92
|
| 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 |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,762.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,468.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.00
|
| Rate for Payer: United Healthcare All Other HMO |
$979.00
|
| Rate for Payer: United Healthcare HMO Rider |
$979.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$979.00
|
| 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 LDCT LUNG CANCER SCREENING
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT G0297
|
| Hospital Charge Code |
909200297
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,182.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.19
|
| Rate for Payer: Blue Shield of California Commercial |
$182.10
|
| Rate for Payer: Blue Shield of California EPN |
$119.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC LDCT LUNG CANCER SCREENING
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT G0297
|
| Hospital Charge Code |
909200297
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC L&D EA ADD'L 15 MIN
|
Facility
|
OP
|
$1,009.00
|
|
| Hospital Charge Code |
902400057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$201.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$857.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$554.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$756.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$488.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$592.59
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Central Health Plan Commercial |
$807.20
|
| Rate for Payer: Cigna of CA HMO |
$645.76
|
| Rate for Payer: Cigna of CA PPO |
$746.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$857.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$857.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$857.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.60
|
| Rate for Payer: EPIC Health Plan Senior |
$403.60
|
| Rate for Payer: Galaxy Health WC |
$857.65
|
| Rate for Payer: Global Benefits Group Commercial |
$605.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$908.10
|
| Rate for Payer: InnovAge PACE Commercial |
$504.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$624.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$706.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$706.30
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
| Rate for Payer: Networks By Design Commercial |
$655.85
|
| Rate for Payer: Prime Health Services Commercial |
$857.65
|
| Rate for Payer: Riverside University Health System MISP |
$403.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$605.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.50
|
| Rate for Payer: United Healthcare All Other HMO |
$504.50
|
| Rate for Payer: United Healthcare HMO Rider |
$504.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$504.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$857.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$857.65
|
| Rate for Payer: Vantage Medical Group Senior |
$857.65
|
|
|
HC L&D EA ADD'L 15 MIN
|
Facility
|
IP
|
$1,009.00
|
|
| Hospital Charge Code |
902400057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$908.10 |
| Rate for Payer: Adventist Health Commercial |
$201.80
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Central Health Plan Commercial |
$807.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.60
|
| Rate for Payer: EPIC Health Plan Senior |
$403.60
|
| Rate for Payer: Galaxy Health WC |
$857.65
|
| Rate for Payer: Global Benefits Group Commercial |
$605.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$908.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$624.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
| Rate for Payer: Networks By Design Commercial |
$655.85
|
| Rate for Payer: Prime Health Services Commercial |
$857.65
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
IP
|
$4,772.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$954.40 |
| Max. Negotiated Rate |
$4,294.80 |
| Rate for Payer: Adventist Health Commercial |
$954.40
|
| Rate for Payer: Cash Price |
$2,147.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,817.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,908.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,908.80
|
| Rate for Payer: Galaxy Health WC |
$4,056.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,863.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,294.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,182.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,818.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,953.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$954.40
|
| Rate for Payer: Multiplan Commercial |
$3,579.00
|
| Rate for Payer: Networks By Design Commercial |
$3,101.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,056.20
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
OP
|
$4,772.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$954.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$954.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,056.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,624.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,579.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,310.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,802.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,147.40
|
| Rate for Payer: Cash Price |
$2,147.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,817.60
|
| Rate for Payer: Cigna of CA HMO |
$3,054.08
|
| Rate for Payer: Cigna of CA PPO |
$3,531.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,056.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,056.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,056.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,908.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,908.80
|
| Rate for Payer: Galaxy Health WC |
$4,056.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,863.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,294.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,386.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,182.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,818.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,953.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$954.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,340.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,340.40
|
| Rate for Payer: Multiplan Commercial |
$3,579.00
|
| Rate for Payer: Networks By Design Commercial |
$3,101.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,056.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,908.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,863.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,386.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,386.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,386.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,056.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,056.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,056.20
|
|
|
HC L&D LEVEL II - 1ST HR
|
Facility
|
OP
|
$5,843.00
|
|
| Hospital Charge Code |
902400052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,168.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,168.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,966.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,213.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,829.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,431.59
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,629.35
|
| Rate for Payer: Cash Price |
$2,629.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,674.40
|
| Rate for Payer: Cigna of CA HMO |
$3,739.52
|
| Rate for Payer: Cigna of CA PPO |
$4,323.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,966.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,966.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,966.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,337.20
|
| Rate for Payer: Galaxy Health WC |
$4,966.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,505.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,258.70
|
| Rate for Payer: InnovAge PACE Commercial |
$2,921.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,897.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,226.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,616.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,168.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,090.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,090.10
|
| Rate for Payer: Multiplan Commercial |
$4,382.25
|
| Rate for Payer: Networks By Design Commercial |
$3,797.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,966.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,337.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,505.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,921.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,921.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,921.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,921.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,966.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,966.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,966.55
|
|
|
HC L&D LEVEL II - 1ST HR
|
Facility
|
IP
|
$5,843.00
|
|
| Hospital Charge Code |
902400052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,168.60 |
| Max. Negotiated Rate |
$5,258.70 |
| Rate for Payer: Adventist Health Commercial |
$1,168.60
|
| Rate for Payer: Cash Price |
$2,629.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,674.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,337.20
|
| Rate for Payer: Galaxy Health WC |
$4,966.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,505.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,258.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,897.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,226.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,616.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,168.60
|
| Rate for Payer: Multiplan Commercial |
$4,382.25
|
| Rate for Payer: Networks By Design Commercial |
$3,797.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,966.55
|
|
|
HC L&D LEVEL III - 1ST HR
|
Facility
|
OP
|
$6,854.00
|
|
| Hospital Charge Code |
902400054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,370.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,370.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,825.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,769.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,140.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,318.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,025.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,084.30
|
| Rate for Payer: Cash Price |
$3,084.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,483.20
|
| Rate for Payer: Cigna of CA HMO |
$4,386.56
|
| Rate for Payer: Cigna of CA PPO |
$5,071.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,825.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,825.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,825.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,741.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,741.60
|
| Rate for Payer: Galaxy Health WC |
$5,825.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,112.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,168.60
|
| Rate for Payer: InnovAge PACE Commercial |
$3,427.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,611.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,242.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,370.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,797.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,797.80
|
| Rate for Payer: Multiplan Commercial |
$5,140.50
|
| Rate for Payer: Networks By Design Commercial |
$4,455.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,825.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,741.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,112.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,427.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,427.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,427.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,427.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,825.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,825.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,825.90
|
|
|
HC L&D LEVEL III - 1ST HR
|
Facility
|
IP
|
$6,854.00
|
|
| Hospital Charge Code |
902400054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,370.80 |
| Max. Negotiated Rate |
$6,168.60 |
| Rate for Payer: Adventist Health Commercial |
$1,370.80
|
| Rate for Payer: Cash Price |
$3,084.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,483.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,741.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,741.60
|
| Rate for Payer: Galaxy Health WC |
$5,825.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,112.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,168.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,611.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,242.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,370.80
|
| Rate for Payer: Multiplan Commercial |
$5,140.50
|
| Rate for Payer: Networks By Design Commercial |
$4,455.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,825.90
|
|
