|
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: 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
|
|
|
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
|
450
|
| 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: 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
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,272.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,334.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,037.17
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.80
|
| Rate for Payer: Cigna of CA HMO |
$1,357.44
|
| Rate for Payer: Cigna of CA PPO |
$1,569.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,802.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,908.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,590.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.20
|
| 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 |
$1,590.75
|
| Rate for Payer: Networks By Design Commercial |
$1,378.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.85
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,272.60
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,272.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,060.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,060.50
|
| 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 5.1 - 7.5 CM
|
Facility
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,272.60
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.80
|
| Rate for Payer: Cigna of CA PPO |
$1,569.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,802.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,908.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,590.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.20
|
| 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 |
$1,590.75
|
| Rate for Payer: Networks By Design Commercial |
$1,378.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.85
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,272.60
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,060.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,060.50
|
| 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 5.1 - 7.5 CM
|
Facility
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.20 |
| Max. Negotiated Rate |
$1,908.90 |
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.40
|
| Rate for Payer: Galaxy Health WC |
$1,802.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,908.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.20
|
| Rate for Payer: Multiplan Commercial |
$1,590.75
|
| Rate for Payer: Networks By Design Commercial |
$1,378.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.85
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$424.20 |
| Max. Negotiated Rate |
$1,908.90 |
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.40
|
| Rate for Payer: Galaxy Health WC |
$1,802.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,908.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.20
|
| Rate for Payer: Multiplan Commercial |
$1,590.75
|
| Rate for Payer: Networks By Design Commercial |
$1,378.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.85
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$378.60 |
| Max. Negotiated Rate |
$1,703.70 |
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,514.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.20
|
| Rate for Payer: Galaxy Health WC |
$1,609.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,135.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,703.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,262.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.60
|
| Rate for Payer: Multiplan Commercial |
$1,419.75
|
| Rate for Payer: Networks By Design Commercial |
$1,230.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.05
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,135.80
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,514.40
|
| Rate for Payer: Cigna of CA PPO |
$1,400.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,609.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,135.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,703.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,419.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,262.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.60
|
| 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 |
$1,419.75
|
| Rate for Payer: Networks By Design Commercial |
$1,230.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.05
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,135.80
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,135.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$946.50
|
| Rate for Payer: United Healthcare All Other HMO |
$946.50
|
| Rate for Payer: United Healthcare HMO Rider |
$946.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$946.50
|
| 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 7.6 - 12.5 CM
|
Facility
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.60 |
| Max. Negotiated Rate |
$1,703.70 |
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,514.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.20
|
| Rate for Payer: Galaxy Health WC |
$1,609.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,135.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,703.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,262.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.60
|
| Rate for Payer: Multiplan Commercial |
$1,419.75
|
| Rate for Payer: Networks By Design Commercial |
$1,230.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.05
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,135.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,190.70
|
| Rate for Payer: Blue Shield of California EPN |
$925.68
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,514.40
|
| Rate for Payer: Cigna of CA HMO |
$1,211.52
|
| Rate for Payer: Cigna of CA PPO |
$1,400.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,609.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,135.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,703.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,419.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,262.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.60
|
| 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 |
$1,419.75
|
| Rate for Payer: Networks By Design Commercial |
$1,230.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.05
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,135.80
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,135.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,135.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$946.50
|
| Rate for Payer: United Healthcare All Other HMO |
$946.50
|
| Rate for Payer: United Healthcare HMO Rider |
$946.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$946.50
|
| 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 7.6-12.5CM FACE
|
Facility
IP
|
$2,331.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$466.20 |
| Max. Negotiated Rate |
$2,097.90 |
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,864.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$932.40
|
| Rate for Payer: Galaxy Health WC |
$1,981.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,097.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.20
|
| Rate for Payer: Multiplan Commercial |
$1,748.25
|
| Rate for Payer: Networks By Design Commercial |
$1,515.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,981.35
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
OP
|
$2,331.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,398.60
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,864.80
|
| Rate for Payer: Cigna of CA PPO |
$1,724.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,981.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,097.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,748.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.20
|
| 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 |
$1,748.25
|
| Rate for Payer: Networks By Design Commercial |
$1,515.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,981.35
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,398.60
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,398.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,165.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,165.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,165.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,165.50
|
| 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 7.6-12.5CM FACE
|
Facility
OP
|
$2,331.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,398.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,466.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,139.86
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,864.80
|
| Rate for Payer: Cigna of CA HMO |
$1,491.84
|
| Rate for Payer: Cigna of CA PPO |
$1,724.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,981.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,097.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,748.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.20
|
| 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 |
$1,748.25
|
| Rate for Payer: Networks By Design Commercial |
$1,515.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,981.35
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,398.60
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,398.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,398.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,165.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,165.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,165.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,165.50
|
| 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 7.6-12.5CM FACE
|
Facility
IP
|
$2,331.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$466.20 |
| Max. Negotiated Rate |
$2,097.90 |
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,864.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$932.40
|
| Rate for Payer: Galaxy Health WC |
$1,981.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,097.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.20
|
| Rate for Payer: Multiplan Commercial |
$1,748.25
|
| Rate for Payer: Networks By Design Commercial |
$1,515.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,981.35
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
IP
|
$3,771.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$754.20 |
| Max. Negotiated Rate |
$3,393.90 |
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,016.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.40
|
| Rate for Payer: Galaxy Health WC |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,393.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.20
|
| Rate for Payer: Multiplan Commercial |
$2,828.25
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
OP
|
$3,771.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.14 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$2,262.60
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,016.80
|
| Rate for Payer: Cigna of CA PPO |
$2,790.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,393.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,828.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.20
|
| 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 |
$2,828.25
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,262.60
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,262.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,885.50
|
| 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 LT 2.5 CM
|
Facility
OP
|
$1,703.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,021.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,071.19
|
| Rate for Payer: Blue Shield of California EPN |
$832.77
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: Cigna of CA HMO |
$1,089.92
|
| Rate for Payer: Cigna of CA PPO |
$1,260.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,277.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| 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 |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,021.80
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,021.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,021.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.50
|
| Rate for Payer: United Healthcare All Other HMO |
$851.50
|
| Rate for Payer: United Healthcare HMO Rider |
$851.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.50
|
| 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 LT 2.5 CM
|
Facility
IP
|
$1,703.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$1,532.70 |
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.20
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| Rate for Payer: Multiplan Commercial |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
IP
|
$1,703.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$1,532.70 |
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.20
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| Rate for Payer: Multiplan Commercial |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
OP
|
$1,703.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,021.80
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: Cigna of CA PPO |
$1,260.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,277.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| 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 |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,021.80
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,021.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.50
|
| Rate for Payer: United Healthcare All Other HMO |
$851.50
|
| Rate for Payer: United Healthcare HMO Rider |
$851.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.50
|
| 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 LT 2.5 CM
|
Facility
IP
|
$1,703.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$1,532.70 |
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.20
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| Rate for Payer: Multiplan Commercial |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
OP
|
$1,703.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,021.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: Cigna of CA PPO |
$1,260.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,277.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| 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 |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,021.80
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,021.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| 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 LT 2.5CM FACE
|
Facility
OP
|
$1,696.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.14 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,017.60
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,272.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| 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 |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| 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 LT 2.5CM FACE
|
Facility
OP
|
$1,696.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$332.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,017.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,272.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| 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 |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| 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 LT 2.5CM FACE
|
Facility
IP
|
$1,696.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
