|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$2,252.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.98 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$450.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,801.60
|
| Rate for Payer: Cigna of CA HMO |
$1,441.28
|
| Rate for Payer: Cigna of CA PPO |
$1,666.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,576.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,914.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,026.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,689.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,463.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,914.20
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,126.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,126.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,126.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$2,252.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$450.40 |
| Max. Negotiated Rate |
$2,026.80 |
| Rate for Payer: Adventist Health Commercial |
$450.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,801.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,576.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$900.80
|
| Rate for Payer: EPIC Health Plan Senior |
$900.80
|
| Rate for Payer: Galaxy Health WC |
$1,914.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,026.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,328.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.40
|
| Rate for Payer: Multiplan Commercial |
$1,689.00
|
| Rate for Payer: Networks By Design Commercial |
$1,463.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,914.20
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$2,252.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$132.98 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$923.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,801.60
|
| Rate for Payer: Cigna of CA HMO |
$1,441.28
|
| Rate for Payer: Cigna of CA PPO |
$1,666.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,576.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,914.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,026.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,689.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,463.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,914.20
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,351.20
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$2,252.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$450.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,801.60
|
| Rate for Payer: Cigna of CA HMO |
$1,441.28
|
| Rate for Payer: Cigna of CA PPO |
$1,666.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,576.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,914.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,026.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,689.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,463.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,914.20
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.40 |
| Max. Negotiated Rate |
$2,017.80 |
| Rate for Payer: Adventist Health Commercial |
$448.40
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,793.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,569.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.80
|
| Rate for Payer: EPIC Health Plan Senior |
$896.80
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,345.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,017.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,423.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,322.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.40
|
| Rate for Payer: Multiplan Commercial |
$1,681.50
|
| Rate for Payer: Networks By Design Commercial |
$1,457.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,905.70
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$448.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,793.60
|
| Rate for Payer: Cigna of CA HMO |
$1,434.88
|
| Rate for Payer: Cigna of CA PPO |
$1,659.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,569.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,345.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,017.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,423.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,681.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,457.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,905.70
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,345.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,121.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,121.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,121.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$919.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$359.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,793.60
|
| Rate for Payer: Cigna of CA HMO |
$1,434.88
|
| Rate for Payer: Cigna of CA PPO |
$1,659.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,569.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,345.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,017.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,423.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,681.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,457.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,905.70
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,345.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,345.20
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.40 |
| Max. Negotiated Rate |
$2,017.80 |
| Rate for Payer: Adventist Health Commercial |
$448.40
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,793.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,569.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.80
|
| Rate for Payer: EPIC Health Plan Senior |
$896.80
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,345.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,017.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,423.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,322.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.40
|
| Rate for Payer: Multiplan Commercial |
$1,681.50
|
| Rate for Payer: Networks By Design Commercial |
$1,457.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,905.70
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$448.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,793.60
|
| Rate for Payer: Cigna of CA HMO |
$1,434.88
|
| Rate for Payer: Cigna of CA PPO |
$1,659.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,569.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,345.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,017.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,423.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,681.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,457.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,905.70
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,345.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$448.40 |
| Max. Negotiated Rate |
$2,017.80 |
| Rate for Payer: Adventist Health Commercial |
$448.40
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,793.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,569.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.80
|
| Rate for Payer: EPIC Health Plan Senior |
$896.80
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,345.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,017.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,423.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,322.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.40
|
| Rate for Payer: Multiplan Commercial |
$1,681.50
|
| Rate for Payer: Networks By Design Commercial |
$1,457.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,905.70
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$758.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,032.00
|
| Rate for Payer: Cigna of CA HMO |
$2,425.60
|
| Rate for Payer: Cigna of CA PPO |
$2,804.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,653.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$3,221.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,274.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,411.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,406.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$2,842.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$2,463.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$3,221.50
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,274.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,895.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,895.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,895.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
IP
|
$3,790.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$758.00 |
| Max. Negotiated Rate |
$3,411.00 |
| Rate for Payer: Adventist Health Commercial |
$758.00
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,032.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,653.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,516.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,516.00
|
| Rate for Payer: Galaxy Health WC |
$3,221.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,274.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,411.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,406.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,236.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.00
|
| Rate for Payer: Multiplan Commercial |
$2,842.50
|
| Rate for Payer: Networks By Design Commercial |
$2,463.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,221.50
|
|
|
HC SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
IP
|
$4,120.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$824.00 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Adventist Health Commercial |
$824.00
|
| Rate for Payer: Cash Price |
$1,854.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,296.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,648.00
|
| Rate for Payer: Galaxy Health WC |
$3,502.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,472.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,708.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,616.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,430.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.00
|
| Rate for Payer: Multiplan Commercial |
$3,090.00
|
| Rate for Payer: Networks By Design Commercial |
$2,678.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,502.00
|
|
|
HC SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
OP
|
$4,120.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$824.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,854.00
|
| Rate for Payer: Cash Price |
$1,854.00
|
| Rate for Payer: Cash Price |
$1,854.00
|
| Rate for Payer: Cash Price |
$1,854.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,296.00
|
| Rate for Payer: Cigna of CA HMO |
$2,636.80
|
| Rate for Payer: Cigna of CA PPO |
$3,048.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$3,502.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,472.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,708.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,616.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$3,090.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,678.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,502.00
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,060.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,060.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,060.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,060.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
IP
|
$4,533.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$906.60 |
| Max. Negotiated Rate |
$4,079.70 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,173.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,813.20
|
| Rate for Payer: Galaxy Health WC |
$3,853.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,079.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,878.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,674.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Networks By Design Commercial |
$2,946.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,853.05
|
|
|
HC SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
OP
|
$4,533.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| Rate for Payer: Cigna of CA HMO |
$2,901.12
|
| Rate for Payer: Cigna of CA PPO |
$3,354.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,173.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$3,853.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,079.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,878.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$618.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,946.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,853.05
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,719.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,266.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,266.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,266.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,266.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SIMULATION 3D COMPUTER
|
Facility
|
IP
|
$27,041.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$5,408.20 |
| Max. Negotiated Rate |
$24,336.90 |
| Rate for Payer: Adventist Health Commercial |
$5,408.20
|
| Rate for Payer: Cash Price |
$12,168.45
|
| Rate for Payer: Central Health Plan Commercial |
$21,632.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,928.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,816.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,816.40
|
| Rate for Payer: Galaxy Health WC |
$22,984.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,224.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,336.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,171.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,954.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,408.20
|
| Rate for Payer: Multiplan Commercial |
$20,280.75
|
| Rate for Payer: Networks By Design Commercial |
$17,576.65
|
| Rate for Payer: Prime Health Services Commercial |
$22,984.85
|
|
|
HC SIMULATION 3D COMPUTER
|
Facility
|
OP
|
$27,041.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$739.17 |
| Max. Negotiated Rate |
$24,336.90 |
| Rate for Payer: Adventist Health Commercial |
$5,408.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,780.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,130.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,670.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,958.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,780.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,078.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,059.71
|
| Rate for Payer: Blue Shield of California Commercial |
$17,035.83
|
| Rate for Payer: Blue Shield of California EPN |
$10,735.28
|
| Rate for Payer: Cash Price |
$12,168.45
|
| Rate for Payer: Cash Price |
$12,168.45
|
| Rate for Payer: Cash Price |
$12,168.45
|
| Rate for Payer: Cash Price |
$12,168.45
|
| Rate for Payer: Central Health Plan Commercial |
$21,632.80
|
| Rate for Payer: Cigna of CA HMO |
$17,306.24
|
| Rate for Payer: Cigna of CA PPO |
$20,010.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,670.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,958.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,780.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,928.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,937.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1,958.24
|
| Rate for Payer: Galaxy Health WC |
$22,984.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,224.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,336.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,919.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$739.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,780.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,171.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$816.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,492.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,408.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,385.49
|
| Rate for Payer: Multiplan Commercial |
$20,280.75
|
| Rate for Payer: Networks By Design Commercial |
$17,576.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,780.22
|
| Rate for Payer: Prime Health Services Commercial |
$22,984.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,887.03
|
| Rate for Payer: Riverside University Health System MISP |
$1,958.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,224.60
|
| 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 |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,670.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,958.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.22
|
|
|
HC SIMULATION COMPLEX
|
Facility
|
IP
|
$5,822.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,164.40 |
| Max. Negotiated Rate |
$5,239.80 |
| Rate for Payer: Adventist Health Commercial |
$1,164.40
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,657.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,075.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,328.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,328.80
|
| Rate for Payer: Galaxy Health WC |
$4,948.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,493.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,239.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,696.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,434.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.40
|
| Rate for Payer: Multiplan Commercial |
$4,366.50
|
| Rate for Payer: Networks By Design Commercial |
$3,784.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,948.70
|
|
|
HC SIMULATION COMPLEX
|
Facility
|
OP
|
$5,822.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$268.13 |
| Max. Negotiated Rate |
$5,239.80 |
| Rate for Payer: Adventist Health Commercial |
$1,164.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$481.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,874.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,176.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,636.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,667.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,311.33
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,657.60
|
| Rate for Payer: Cigna of CA HMO |
$3,726.08
|
| Rate for Payer: Cigna of CA PPO |
$4,308.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,075.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$4,948.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,493.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,239.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$268.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,696.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$296.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$4,366.50
|
| Rate for Payer: Networks By Design Commercial |
$3,784.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$481.58
|
| Rate for Payer: Prime Health Services Commercial |
$4,948.70
|
| Rate for Payer: Prime Health Services Medicare |
$510.47
|
| Rate for Payer: Riverside University Health System MISP |
$529.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,493.20
|
| 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 |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC SIMULATION INTER
|
Facility
|
OP
|
$2,486.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$218.47 |
| Max. Negotiated Rate |
$2,237.40 |
| Rate for Payer: Adventist Health Commercial |
$497.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$481.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,771.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,011.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,405.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,566.18
|
| Rate for Payer: Blue Shield of California EPN |
$986.94
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,988.80
|
| Rate for Payer: Cigna of CA HMO |
$1,591.04
|
| Rate for Payer: Cigna of CA PPO |
$1,839.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,740.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$2,113.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,491.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,237.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$218.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,578.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$1,864.50
|
| Rate for Payer: Networks By Design Commercial |
$1,615.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$481.58
|
| Rate for Payer: Prime Health Services Commercial |
$2,113.10
|
| Rate for Payer: Prime Health Services Medicare |
$510.47
|
| Rate for Payer: Riverside University Health System MISP |
$529.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,491.60
|
| 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 |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC SIMULATION INTER
|
Facility
|
IP
|
$2,486.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$497.20 |
| Max. Negotiated Rate |
$2,237.40 |
| Rate for Payer: Adventist Health Commercial |
$497.20
|
| Rate for Payer: Cash Price |
$1,118.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,988.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,740.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Senior |
$994.40
|
| Rate for Payer: Galaxy Health WC |
$2,113.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,491.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,237.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,578.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,466.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.20
|
| Rate for Payer: Multiplan Commercial |
$1,864.50
|
| Rate for Payer: Networks By Design Commercial |
$1,615.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,113.10
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
IP
|
$2,786.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$557.20 |
| Max. Negotiated Rate |
$2,507.40 |
| Rate for Payer: Adventist Health Commercial |
$557.20
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,228.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,114.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,114.40
|
| Rate for Payer: Galaxy Health WC |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,507.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$2,089.50
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
OP
|
$2,786.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$137.84 |
| Max. Negotiated Rate |
$2,507.40 |
| Rate for Payer: Adventist Health Commercial |
$557.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$172.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$978.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$629.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$875.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,755.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,106.04
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,228.80
|
| Rate for Payer: Cigna of CA HMO |
$1,783.04
|
| Rate for Payer: Cigna of CA PPO |
$2,061.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.24
|
| Rate for Payer: EPIC Health Plan Senior |
$190.16
|
| Rate for Payer: Galaxy Health WC |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,507.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$2,089.50
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$172.87
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
| Rate for Payer: Prime Health Services Medicare |
$183.24
|
| Rate for Payer: Riverside University Health System MISP |
$190.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,671.60
|
| 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 |
$172.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Adventist Health Commercial |
$212.80
|
| Rate for Payer: Adventist Health Commercial |
$173.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$732.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$732.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| 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 Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.49
|
| Rate for Payer: Blue Shield of California Commercial |
$544.95
|
| Rate for Payer: Blue Shield of California Commercial |
$670.32
|
| Rate for Payer: Blue Shield of California EPN |
$343.40
|
| Rate for Payer: Blue Shield of California EPN |
$422.41
|
| Rate for Payer: Cash Price |
$389.25
|
| Rate for Payer: Cash Price |
$389.25
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Central Health Plan Commercial |
$851.20
|
| Rate for Payer: Central Health Plan Commercial |
$692.00
|
| Rate for Payer: Cigna of CA HMO |
$553.60
|
| Rate for Payer: Cigna of CA HMO |
$680.96
|
| Rate for Payer: Cigna of CA PPO |
$640.10
|
| Rate for Payer: Cigna of CA PPO |
$787.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$605.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: Galaxy Health WC |
$735.25
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$519.00
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$778.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$957.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$549.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$648.75
|
| Rate for Payer: Multiplan Commercial |
$798.00
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Networks By Design Commercial |
$562.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$323.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$323.75
|
| Rate for Payer: Prime Health Services Commercial |
$735.25
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Riverside University Health System MISP |
$356.12
|
| Rate for Payer: Riverside University Health System MISP |
$356.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$638.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$519.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$519.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$638.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| 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 All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| 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 Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
