|
HC SIGMDSCPY W TUMOR SNARE RMVL
|
Facility
|
IP
|
$4,581.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
906745338
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$916.20 |
| Max. Negotiated Rate |
$4,122.90 |
| Rate for Payer: Cash Price |
$2,061.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,664.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,832.40
|
| Rate for Payer: Galaxy Health WC |
$3,893.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,748.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,122.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,055.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,745.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$916.20
|
| Rate for Payer: Multiplan Commercial |
$3,435.75
|
| Rate for Payer: Networks By Design Commercial |
$2,977.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,893.85
|
|
|
HC SIGMOIDOSCOPY W ENDO MCSL RESC
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
CPT 45349
|
| Hospital Charge Code |
906745349
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$548.60 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,508.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,645.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$3,508.15
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,194.40
|
| Rate for Payer: Cigna of CA PPO |
$2,029.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Media |
$3,508.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,736.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,508.15
|
| Rate for Payer: Galaxy Health WC |
$2,331.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,645.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,468.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,057.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,753.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,788.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,508.15
|
| Rate for Payer: InnovAge PACE Commercial |
$5,262.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,829.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,508.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,700.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,700.92
|
| Rate for Payer: Multiplan Commercial |
$2,057.25
|
| Rate for Payer: Networks By Design Commercial |
$1,782.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,331.55
|
| Rate for Payer: Prime Health Services Medicare |
$3,718.64
|
| Rate for Payer: Riverside University Health System MISP |
$3,858.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,645.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,209.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC SIGMOIDOSCOPY W ENDO MCSL RESC
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
CPT 45349
|
| Hospital Charge Code |
906745349
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$548.60 |
| Max. Negotiated Rate |
$2,468.70 |
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,194.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.20
|
| Rate for Payer: Galaxy Health WC |
$2,331.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,645.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,468.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,829.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,045.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.60
|
| Rate for Payer: Multiplan Commercial |
$2,057.25
|
| Rate for Payer: Networks By Design Commercial |
$1,782.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,331.55
|
|
|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
OP
|
$5,205.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,041.00 |
| Max. Negotiated Rate |
$11,749.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,120.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,123.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$7,120.83
|
| Rate for Payer: Cash Price |
$2,342.25
|
| Rate for Payer: Cash Price |
$2,342.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,164.00
|
| Rate for Payer: Cigna of CA PPO |
$3,851.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Media |
$7,120.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,613.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,120.83
|
| Rate for Payer: Galaxy Health WC |
$4,424.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,684.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,903.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,678.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,749.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,120.83
|
| Rate for Payer: InnovAge PACE Commercial |
$10,681.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,471.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,041.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,541.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.91
|
| Rate for Payer: Multiplan Commercial |
$3,903.75
|
| Rate for Payer: Networks By Design Commercial |
$3,383.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,424.25
|
| Rate for Payer: Prime Health Services Medicare |
$7,548.08
|
| Rate for Payer: Riverside University Health System MISP |
$7,832.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
IP
|
$8,199.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,639.80 |
| Max. Negotiated Rate |
$7,379.10 |
| Rate for Payer: Cash Price |
$3,689.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,559.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,279.60
|
| Rate for Payer: Galaxy Health WC |
$6,969.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,919.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,379.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,468.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,123.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.80
|
| Rate for Payer: Multiplan Commercial |
$6,149.25
|
| Rate for Payer: Networks By Design Commercial |
$5,329.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,969.15
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$291.67 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,141.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$979.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,141.93
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,306.40
|
| Rate for Payer: Cigna of CA PPO |
$1,208.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$1,388.05
|
| Rate for Payer: Global Benefits Group Commercial |
$979.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,469.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,224.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,884.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,089.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$1,224.75
|
| Rate for Payer: Networks By Design Commercial |
$1,061.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,256.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,370.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$291.67 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,141.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$979.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,027.16
|
| Rate for Payer: Blue Shield of California EPN |
$798.54
|
| Rate for Payer: Caremore Medicare Advantage |
$1,141.93
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,306.40
|
| Rate for Payer: Cigna of CA HMO |
$1,045.12
|
| Rate for Payer: Cigna of CA PPO |
$1,208.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$1,388.05
|
| Rate for Payer: Global Benefits Group Commercial |
$979.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,469.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,224.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,884.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,089.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$1,224.75
|
| Rate for Payer: Networks By Design Commercial |
$1,061.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,256.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$816.50
|
| Rate for Payer: United Healthcare All Other HMO |
$816.50
|
| Rate for Payer: United Healthcare HMO Rider |
$816.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$816.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
IP
|
$3,177.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$635.40 |
| Max. Negotiated Rate |
$2,859.30 |
| Rate for Payer: Cash Price |
$1,429.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,541.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,270.80
|
| Rate for Payer: Galaxy Health WC |
$2,700.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,906.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,859.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,119.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,210.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.40
|
| Rate for Payer: Multiplan Commercial |
$2,382.75
|
| Rate for Payer: Networks By Design Commercial |
$2,065.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,700.45
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
IP
|
$3,177.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$635.40 |
| Max. Negotiated Rate |
$2,859.30 |
| Rate for Payer: Cash Price |
$1,429.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,541.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,270.80
|
| Rate for Payer: Galaxy Health WC |
$2,700.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,906.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,859.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,119.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,210.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.40
|
| Rate for Payer: Multiplan Commercial |
$2,382.75
|
| Rate for Payer: Networks By Design Commercial |
$2,065.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,700.45
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$2,329.20 |
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,070.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,035.20
|
| Rate for Payer: Galaxy Health WC |
$2,199.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,329.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,726.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.60
|
| Rate for Payer: Multiplan Commercial |
$1,941.00
|
| Rate for Payer: Networks By Design Commercial |
$1,682.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,199.80
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,474.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,552.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,070.40
|
| Rate for Payer: Cigna of CA PPO |
$1,915.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Media |
$1,474.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$2,199.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,329.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,941.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,432.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: InnovAge PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,726.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$1,941.00
|
| Rate for Payer: Networks By Design Commercial |
$1,682.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,199.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Riverside University Health System MISP |
$1,621.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,552.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC SILVERHAWK THROMB CATH
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$23,685.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,685.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,268.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,268.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,997.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,437.05
|
| Rate for Payer: Blue Distinction Transplant |
$2,475.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,594.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,017.12
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,300.00
|
| Rate for Payer: Cigna of CA HMO |
$2,640.00
|
| Rate for Payer: Cigna of CA PPO |
$3,052.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Dignity Health Media |
$3,506.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,712.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,093.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,443.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.00
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,650.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,062.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,506.25
|
|
|
HC SILVERHAWK THROMB CATH
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,712.50 |
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,712.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.00
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,876.50 |
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,668.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$834.00
|
| Rate for Payer: Galaxy Health WC |
$1,772.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,251.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,876.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$1,563.75
|
| Rate for Payer: Networks By Design Commercial |
$1,355.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,772.25
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,876.50 |
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,668.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$834.00
|
| Rate for Payer: Galaxy Health WC |
$1,772.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,251.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,876.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$1,563.75
|
| Rate for Payer: Networks By Design Commercial |
$1,355.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,772.25
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$6,248.00 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,251.00
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,668.00
|
| Rate for Payer: Cigna of CA PPO |
$1,542.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,772.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,251.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,876.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,563.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,563.75
|
| Rate for Payer: Networks By Design Commercial |
$1,355.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,772.25
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,251.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,042.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,042.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,251.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,311.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,019.56
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Cash Price |
$938.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,668.00
|
| Rate for Payer: Cigna of CA HMO |
$1,334.40
|
| Rate for Payer: Cigna of CA PPO |
$1,542.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,772.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,251.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,876.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,563.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,563.75
|
| Rate for Payer: Networks By Design Commercial |
$1,355.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,772.25
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,251.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,251.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,042.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,042.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,042.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
OP
|
$2,604.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$6,248.00 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,562.40
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,083.20
|
| Rate for Payer: Cigna of CA PPO |
$1,926.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,213.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,562.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,343.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,953.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,736.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,953.00
|
| Rate for Payer: Networks By Design Commercial |
$1,692.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,213.40
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,562.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,302.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,302.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,302.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
IP
|
$2,604.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$2,343.60 |
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,083.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,041.60
|
| Rate for Payer: Galaxy Health WC |
$2,213.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,562.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,343.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,736.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$992.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.80
|
| Rate for Payer: Multiplan Commercial |
$1,953.00
|
| Rate for Payer: Networks By Design Commercial |
$1,692.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,213.40
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
IP
|
$1,814.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$1,632.60 |
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,451.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$725.60
|
| Rate for Payer: Galaxy Health WC |
$1,541.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,088.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,632.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,209.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.80
|
| Rate for Payer: Multiplan Commercial |
$1,360.50
|
| Rate for Payer: Networks By Design Commercial |
$1,179.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,541.90
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
IP
|
$1,814.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$1,632.60 |
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,451.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$725.60
|
| Rate for Payer: Galaxy Health WC |
$1,541.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,088.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,632.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,209.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.80
|
| Rate for Payer: Multiplan Commercial |
$1,360.50
|
| Rate for Payer: Networks By Design Commercial |
$1,179.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,541.90
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
OP
|
$1,814.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$204.16 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,088.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,141.01
|
| Rate for Payer: Blue Shield of California EPN |
$887.05
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,451.20
|
| Rate for Payer: Cigna of CA HMO |
$1,160.96
|
| Rate for Payer: Cigna of CA PPO |
$1,342.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,541.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,088.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,632.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,360.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,209.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,360.50
|
| Rate for Payer: Networks By Design Commercial |
$1,179.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,541.90
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,088.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,088.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.00
|
| Rate for Payer: United Healthcare All Other HMO |
$907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$907.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
OP
|
$1,814.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.16 |
| Max. Negotiated Rate |
$5,779.00 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,088.40
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,451.20
|
| Rate for Payer: Cigna of CA PPO |
$1,342.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,541.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,088.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,632.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,360.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,209.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,360.50
|
| Rate for Payer: Networks By Design Commercial |
$1,179.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,541.90
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,088.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.00
|
| Rate for Payer: United Healthcare All Other HMO |
$907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$907.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
OP
|
$1,758.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$197.98 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,054.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,105.78
|
| Rate for Payer: Blue Shield of California EPN |
$859.66
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,406.40
|
| Rate for Payer: Cigna of CA HMO |
$1,125.12
|
| Rate for Payer: Cigna of CA PPO |
$1,300.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,582.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,318.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,054.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,054.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$879.00
|
| Rate for Payer: United Healthcare All Other HMO |
$879.00
|
| Rate for Payer: United Healthcare HMO Rider |
$879.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$879.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
IP
|
$1,758.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$1,582.20 |
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.20
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,582.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
|
