|
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
|
516
|
| 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
|
|
|
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
|
450
|
| 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
|
|
|
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
|
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 |
$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 |
$1,066.78
|
| Rate for Payer: Blue Shield of California EPN |
$829.34
|
| 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 HMO |
$1,085.44
|
| 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: TriValley Medical Group Commercial/Senior |
$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 OVER 30.0 CM
|
Facility
IP
|
$2,866.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$573.20 |
| Max. Negotiated Rate |
$2,579.40 |
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,292.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,146.40
|
| Rate for Payer: Galaxy Health WC |
$2,436.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,719.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,579.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,911.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.20
|
| Rate for Payer: Multiplan Commercial |
$2,149.50
|
| Rate for Payer: Networks By Design Commercial |
$1,862.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,436.10
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
OP
|
$2,866.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
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 |
$1,719.60
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,292.80
|
| Rate for Payer: Cigna of CA PPO |
$2,120.84
|
| 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 |
$2,436.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,719.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,579.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,149.50
|
| 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 |
$1,911.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.20
|
| 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 |
$2,149.50
|
| Rate for Payer: Networks By Design Commercial |
$1,862.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,436.10
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,719.60
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,719.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,433.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,433.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,433.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,433.00
|
| 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 SIM REP SUP WND 12.6-20CM FACE
|
Facility
IP
|
$3,116.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$623.20 |
| Max. Negotiated Rate |
$2,804.40 |
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,492.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.40
|
| Rate for Payer: Galaxy Health WC |
$2,648.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,869.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,804.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,078.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.20
|
| Rate for Payer: Multiplan Commercial |
$2,337.00
|
| Rate for Payer: Networks By Design Commercial |
$2,025.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,648.60
|
|
|
HC SIM REP SUP WND 12.6-20CM FACE
|
Facility
OP
|
$3,116.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| 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 |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,869.60
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,492.80
|
| Rate for Payer: Cigna of CA PPO |
$2,305.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| 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 |
$2,648.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,869.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,804.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,337.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,078.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.20
|
| 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 |
$2,337.00
|
| Rate for Payer: Networks By Design Commercial |
$2,025.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,648.60
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,869.60
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,869.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,558.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,558.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,558.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,558.00
|
| 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 SIM REP SUP WND 20.1-30CM FACE
|
Facility
OP
|
$3,428.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| 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 |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$2,056.80
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,742.40
|
| Rate for Payer: Cigna of CA PPO |
$2,536.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| 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 |
$2,913.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,056.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,085.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,571.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,286.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.60
|
| 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 |
$2,571.00
|
| Rate for Payer: Networks By Design Commercial |
$2,228.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,913.80
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,056.80
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,056.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,714.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,714.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,714.00
|
| 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 SIM REP SUP WND 20.1-30CM FACE
|
Facility
IP
|
$3,428.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$685.60 |
| Max. Negotiated Rate |
$3,085.20 |
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,742.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,371.20
|
| Rate for Payer: Galaxy Health WC |
$2,913.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,056.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,085.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,286.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.60
|
| Rate for Payer: Multiplan Commercial |
$2,571.00
|
| Rate for Payer: Networks By Design Commercial |
$2,228.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,913.80
|
|
|
HC SIMULATION 3D COMPUTER
|
Facility
OP
|
$20,447.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,161.00 |
| Max. Negotiated Rate |
$18,402.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,731.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,881.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,731.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,078.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,193.96
|
| Rate for Payer: BCBS Transplant Transplant |
$12,268.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,636.25
|
| Rate for Payer: Blue Shield of California EPN |
$9,937.24
|
| Rate for Payer: Caremore Medicare Advantage |
$1,731.24
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Central Health Plan Commercial |
$16,357.60
|
| Rate for Payer: Cigna of CA HMO |
$13,086.08
|
| Rate for Payer: Cigna of CA PPO |
$15,130.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,596.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,337.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,731.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,731.24
|
| Rate for Payer: Galaxy Health WC |
$17,379.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,268.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,402.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15,335.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,839.23
|
| Rate for Payer: IEHP medi-cal |
$2,856.55
|
| Rate for Payer: IEHP Medicare Advantage |
$1,731.24
|
| Rate for Payer: Innovage PACE Commercial |
$2,596.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,638.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,731.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,089.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,319.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,319.86
|
| Rate for Payer: Multiplan Commercial |
$15,335.25
|
| Rate for Payer: Networks By Design Commercial |
$13,290.55
|
| Rate for Payer: Prime Health Services Commercial |
$17,379.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,835.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12,268.20
|
| Rate for Payer: Riverside University Health MISP |
$1,904.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,268.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,731.24
|
|
|
HC SIMULATION 3D COMPUTER
|
Facility
IP
|
$20,447.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
909100250
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$4,089.40 |
| Max. Negotiated Rate |
$18,402.30 |
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Central Health Plan Commercial |
$16,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,178.80
|
| Rate for Payer: Galaxy Health WC |
$17,379.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,268.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,402.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,638.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,089.40
|
| Rate for Payer: Multiplan Commercial |
$15,335.25
|
| Rate for Payer: Networks By Design Commercial |
$13,290.55
|
| Rate for Payer: Prime Health Services Commercial |
$17,379.95
|
|
|
HC SIMULATION COMPLEX
|
Facility
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$4,556.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$461.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,539.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,176.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,435.55
|
| Rate for Payer: BCBS Transplant Transplant |
$3,037.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,128.93
|
| Rate for Payer: Blue Shield of California EPN |
$2,460.62
|
| Rate for Payer: Caremore Medicare Advantage |
$461.66
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: Cigna of CA HMO |
$3,240.32
|
| Rate for Payer: Cigna of CA PPO |
$3,746.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,797.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$757.12
|
| Rate for Payer: IEHP medi-cal |
$761.74
|
| Rate for Payer: IEHP Medicare Advantage |
$461.66
|
| Rate for Payer: Innovage PACE Commercial |
$692.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,377.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
| Rate for Payer: Prime Health Services Medicare |
$489.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,180.00
|
| Rate for Payer: Riverside University Health MISP |
$507.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,037.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC SIMULATION COMPLEX
|
Facility
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
904810301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,012.60 |
| Max. Negotiated Rate |
$4,556.70 |
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,025.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.20
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,377.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
|
|
HC SIMULATION INTER
|
Facility
IP
|
$1,880.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$752.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$752.00
|
| Rate for Payer: Galaxy Health WC |
$1,598.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,128.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,692.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.00
|
| Rate for Payer: Multiplan Commercial |
$1,410.00
|
| Rate for Payer: Networks By Design Commercial |
$1,222.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,598.00
|
|
|
HC SIMULATION INTER
|
Facility
OP
|
$1,880.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$4,180.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$461.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,565.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,011.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.57
|
| Rate for Payer: BCBS Transplant Transplant |
$1,128.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,161.84
|
| Rate for Payer: Blue Shield of California EPN |
$913.68
|
| Rate for Payer: Caremore Medicare Advantage |
$461.66
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,504.00
|
| Rate for Payer: Cigna of CA HMO |
$1,203.20
|
| Rate for Payer: Cigna of CA PPO |
$1,391.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$1,598.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,128.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,692.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,410.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$757.12
|
| Rate for Payer: IEHP medi-cal |
$761.74
|
| Rate for Payer: IEHP Medicare Advantage |
$461.66
|
| Rate for Payer: Innovage PACE Commercial |
$692.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$1,410.00
|
| Rate for Payer: Networks By Design Commercial |
$1,222.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,598.00
|
| Rate for Payer: Prime Health Services Medicare |
$489.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,180.00
|
| Rate for Payer: Riverside University Health MISP |
$507.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,128.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC SIMULATION SIMPLE
|
Facility
IP
|
$2,423.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$484.60 |
| Max. Negotiated Rate |
$2,180.70 |
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,938.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$969.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$969.20
|
| Rate for Payer: Galaxy Health WC |
$2,059.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,180.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,616.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.60
|
| Rate for Payer: Multiplan Commercial |
$1,817.25
|
| Rate for Payer: Networks By Design Commercial |
$1,574.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,059.55
|
|
|
HC SIMULATION SIMPLE
|
Facility
OP
|
$2,423.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$4,180.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$169.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$864.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$629.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$768.02
|
| Rate for Payer: BCBS Transplant Transplant |
$1,453.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,497.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,177.58
|
| Rate for Payer: Caremore Medicare Advantage |
$169.53
|
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,938.40
|
| Rate for Payer: Cigna of CA HMO |
$1,550.72
|
| Rate for Payer: Cigna of CA PPO |
$1,793.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$2,059.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,180.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,817.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$278.03
|
| Rate for Payer: IEHP medi-cal |
$279.72
|
| Rate for Payer: IEHP Medicare Advantage |
$169.53
|
| Rate for Payer: Innovage PACE Commercial |
$254.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,616.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,817.25
|
| Rate for Payer: Networks By Design Commercial |
$1,574.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,059.55
|
| Rate for Payer: Prime Health Services Medicare |
$179.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,180.00
|
| Rate for Payer: Riverside University Health MISP |
$186.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,453.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$732.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$732.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.24
|
| Rate for Payer: BCBS Transplant Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$250.29
|
| Rate for Payer: Blue Shield of California EPN |
$196.83
|
| Rate for Payer: Caremore Medicare Advantage |
$323.75
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$323.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$323.75
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: IEHP medi-cal |
$534.19
|
| Rate for Payer: IEHP Medicare Advantage |
$323.75
|
| Rate for Payer: Innovage PACE Commercial |
$485.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: Riverside University Health MISP |
$356.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
IP
|
$804.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$723.60 |
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Central Health Plan Commercial |
$643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.60
|
| Rate for Payer: Galaxy Health WC |
$683.40
|
| Rate for Payer: Global Benefits Group Commercial |
$482.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$723.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.80
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
| Rate for Payer: Networks By Design Commercial |
$522.60
|
| Rate for Payer: Prime Health Services Commercial |
$683.40
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
IP
|
$804.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$723.60 |
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Central Health Plan Commercial |
$643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.60
|
| Rate for Payer: Galaxy Health WC |
$683.40
|
| Rate for Payer: Global Benefits Group Commercial |
$482.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$723.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.80
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
| Rate for Payer: Networks By Design Commercial |
$522.60
|
| Rate for Payer: Prime Health Services Commercial |
$683.40
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$665.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$665.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$652.00
|
| Rate for Payer: BCBS Transplant Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$250.29
|
| Rate for Payer: Blue Shield of California EPN |
$196.83
|
| Rate for Payer: Caremore Medicare Advantage |
$325.80
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$325.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$325.80
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: IEHP medi-cal |
$537.57
|
| Rate for Payer: IEHP Medicare Advantage |
$325.80
|
| Rate for Payer: Innovage PACE Commercial |
$488.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: Riverside University Health MISP |
$358.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
OP
|
$1,318.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.66 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.56
|
| Rate for Payer: BCBS Transplant Transplant |
$790.80
|
| Rate for Payer: Blue Shield of California Commercial |
$814.52
|
| Rate for Payer: Blue Shield of California EPN |
$640.55
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: Cigna of CA HMO |
$843.52
|
| Rate for Payer: Cigna of CA PPO |
$975.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$988.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: IEHP medi-cal |
$1,137.31
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Innovage PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Networks By Design Commercial |
$856.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$790.80
|
| Rate for Payer: Riverside University Health MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$790.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$790.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
IP
|
$1,318.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Networks By Design Commercial |
$856.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.83
|
| Rate for Payer: BCBS Transplant Transplant |
$930.60
|
| Rate for Payer: Blue Shield of California Commercial |
$958.52
|
| Rate for Payer: Blue Shield of California EPN |
$753.79
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: Cigna of CA HMO |
$992.64
|
| Rate for Payer: Cigna of CA PPO |
$1,147.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,163.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,034.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$930.60
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$930.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$930.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.20 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.40
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,034.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
|
