|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
IP
|
$3,083.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$616.60 |
| Max. Negotiated Rate |
$2,774.70 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| Rate for Payer: Cash Price |
$1,695.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,233.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,233.20
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,774.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,056.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,174.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,908.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.60
|
| Rate for Payer: Multiplan Commercial |
$2,312.25
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.47 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$997.60
|
| 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 |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$402.27
|
| Rate for Payer: Cash Price |
$2,743.40
|
| Rate for Payer: Cash Price |
$2,743.40
|
| Rate for Payer: Cash Price |
$2,743.40
|
| Rate for Payer: Cash Price |
$2,743.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,990.40
|
| Rate for Payer: Cigna of CA HMO |
$3,192.32
|
| Rate for Payer: Cigna of CA PPO |
$3,691.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$4,239.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,992.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,489.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,327.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$3,741.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$3,242.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$4,239.80
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,992.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,494.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,494.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,494.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,494.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$997.60 |
| Max. Negotiated Rate |
$4,489.20 |
| Rate for Payer: Adventist Health Commercial |
$997.60
|
| Rate for Payer: Cash Price |
$2,743.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,990.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,995.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,995.20
|
| Rate for Payer: Galaxy Health WC |
$4,239.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,992.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,489.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,327.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,900.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,087.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.60
|
| Rate for Payer: Multiplan Commercial |
$3,741.00
|
| Rate for Payer: Networks By Design Commercial |
$3,242.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,239.80
|
|
|
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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,322.60
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Cash Price |
$1,238.60
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,914.20
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$2,252.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.40 |
| Max. Negotiated Rate |
$2,026.80 |
| Rate for Payer: Adventist Health Commercial |
$450.40
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,801.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,502.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,393.99
|
| 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
|
450
|
| Min. Negotiated Rate |
$132.98 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$402.27
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Cash Price |
$1,238.60
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,914.20
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$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 |
$1,238.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,801.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,502.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,393.99
|
| 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
|
IP
|
$2,252.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$450.40 |
| Max. Negotiated Rate |
$2,026.80 |
| Rate for Payer: Adventist Health Commercial |
$450.40
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,801.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,502.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,393.99
|
| 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
|
361
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$450.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,090.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,322.60
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Cash Price |
$1,238.60
|
| Rate for Payer: Cash Price |
$1,238.60
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,914.20
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
OP
|
$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 |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,085.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,316.73
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cash Price |
$1,233.10
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,495.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,345.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$2,017.80 |
| 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 |
$1,361.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,316.73
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cash Price |
$1,233.10
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,495.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
IP
|
$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 |
$1,233.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,793.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,495.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$854.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,387.80
|
| 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 |
$2,696.00 |
| 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 |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$402.27
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cash Price |
$1,233.10
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,495.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
IP
|
$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 |
$1,233.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,793.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,495.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$854.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,387.80
|
| 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
|
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 |
$1,233.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,793.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,495.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$854.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,387.80
|
| 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 |
$252.47 |
| Max. Negotiated Rate |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$402.27
|
| Rate for Payer: Cash Price |
$2,084.50
|
| Rate for Payer: Cash Price |
$2,084.50
|
| Rate for Payer: Cash Price |
$2,084.50
|
| Rate for Payer: Cash Price |
$2,084.50
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$3,221.50
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,527.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SIMP REP SUP WND 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 |
$2,084.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,032.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,527.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,346.01
|
| 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
|
OP
|
$4,120.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$6,333.00 |
| 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 |
$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 |
$2,266.00
|
| Rate for Payer: Cash Price |
$2,266.00
|
| Rate for Payer: Cash Price |
$2,266.00
|
| Rate for Payer: Cash Price |
$2,266.00
|
| 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 |
$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 |
$3,502.00
|
| 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 |
$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 |
$2,748.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.00
|
| 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 |
$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 |
$507.64
|
| 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 |
$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 |
$2,472.00
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC SIM REP SUP WND 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 |
$2,266.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,296.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,748.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,569.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,550.28
|
| 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 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 |
$2,493.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| 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 Permanente of CA Commercial/Self Funded |
$3,023.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,727.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.93
|
| 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 |
$6,333.00 |
| 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 |
$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 |
$2,493.15
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Cash Price |
$2,493.15
|
| 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 |
$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 |
$3,853.05
|
| 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 |
$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 |
$3,023.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$618.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| 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 |
$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 |
$507.64
|
| 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 |
$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 |
$2,719.80
|
| 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 |
$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 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 |
$14,872.55
|
| Rate for Payer: Central Health Plan Commercial |
$21,632.80
|
| 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 Permanente of CA Commercial/Self Funded |
$18,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,302.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,738.38
|
| 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 |
$1,738.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16,422.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,738.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,078.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,030.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16,413.89
|
| Rate for Payer: Blue Shield of California EPN |
$10,735.28
|
| Rate for Payer: Cash Price |
$14,872.55
|
| Rate for Payer: Cash Price |
$14,872.55
|
| Rate for Payer: Cash Price |
$14,872.55
|
| 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 |
$2,607.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,912.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,738.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,346.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.51
|
| Rate for Payer: Galaxy Health WC |
$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 |
$2,851.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$739.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,738.51
|
| Rate for Payer: InnovAge PACE Commercial |
$2,607.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,408.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,329.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,329.60
|
| 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 |
$1,738.51
|
| Rate for Payer: Prime Health Services Commercial |
$22,984.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,842.82
|
| Rate for Payer: Riverside University Health System MISP |
$1,912.36
|
| 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 |
$2,607.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,738.51
|
|
|
HC SIMULATION COMPLEX
|
Facility
|
OP
|
$5,822.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$238.86 |
| Max. Negotiated Rate |
$5,239.80 |
| Rate for Payer: Adventist Health Commercial |
$1,164.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$465.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,535.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,176.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3,533.95
|
| Rate for Payer: Blue Shield of California EPN |
$2,311.33
|
| Rate for Payer: Cash Price |
$3,202.10
|
| Rate for Payer: Cash Price |
$3,202.10
|
| Rate for Payer: Cash Price |
$3,202.10
|
| 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 |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$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 |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$268.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: InnovAge PACE Commercial |
$697.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,883.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| 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 |
$465.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,948.70
|
| Rate for Payer: Prime Health Services Medicare |
$493.04
|
| Rate for Payer: Riverside University Health System MISP |
$511.64
|
| 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 |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC SIMULATION 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 |
$3,202.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,657.60
|
| 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 Permanente of CA Commercial/Self Funded |
$3,883.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,603.82
|
| 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
|
|
