|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$414.60 |
| Max. Negotiated Rate |
$1,762.05 |
| Rate for Payer: Adventist Health Commercial |
$414.60
|
| Rate for Payer: Cash Price |
$932.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,451.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$829.20
|
| Rate for Payer: Galaxy Health WC |
$1,762.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,243.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,316.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,223.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.52
|
| Rate for Payer: Multiplan Commercial |
$1,658.40
|
| Rate for Payer: Networks By Design Commercial |
$1,347.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,762.05
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$414.60 |
| Max. Negotiated Rate |
$1,762.05 |
| Rate for Payer: Adventist Health Commercial |
$414.60
|
| Rate for Payer: Cash Price |
$932.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,451.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$829.20
|
| Rate for Payer: Galaxy Health WC |
$1,762.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,243.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,316.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,223.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.52
|
| Rate for Payer: Multiplan Commercial |
$1,658.40
|
| Rate for Payer: Networks By Design Commercial |
$1,347.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,762.05
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$758.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$530.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna of CA HMO |
$1,184.00
|
| Rate for Payer: Cigna of CA PPO |
$1,369.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,295.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,572.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,174.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,480.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,202.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,572.50
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,110.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$370.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna of CA HMO |
$1,184.00
|
| Rate for Payer: Cigna of CA PPO |
$1,369.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,295.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,572.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,174.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,480.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,202.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,572.50
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$925.00
|
| Rate for Payer: United Healthcare All Other HMO |
$925.00
|
| Rate for Payer: United Healthcare HMO Rider |
$925.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$370.00 |
| Max. Negotiated Rate |
$1,572.50 |
| Rate for Payer: Adventist Health Commercial |
$370.00
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,295.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$740.00
|
| Rate for Payer: Galaxy Health WC |
$1,572.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,174.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,091.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$1,480.00
|
| Rate for Payer: Networks By Design Commercial |
$1,202.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,572.50
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$370.00 |
| Max. Negotiated Rate |
$1,572.50 |
| Rate for Payer: EPIC Health Plan Commercial |
$740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$740.00
|
| Rate for Payer: Galaxy Health WC |
$1,572.50
|
| Rate for Payer: Adventist Health Commercial |
$370.00
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,174.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,091.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$1,480.00
|
| Rate for Payer: Networks By Design Commercial |
$1,202.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,572.50
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
OP
|
$2,278.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Adventist Health Commercial |
$933.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$696.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cigna of CA HMO |
$1,457.92
|
| Rate for Payer: Cigna of CA PPO |
$1,685.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,594.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,936.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,446.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,822.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,480.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.30
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,366.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,366.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
IP
|
$2,278.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$455.60 |
| Max. Negotiated Rate |
$1,936.30 |
| Rate for Payer: Adventist Health Commercial |
$455.60
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,594.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.20
|
| Rate for Payer: EPIC Health Plan Senior |
$911.20
|
| Rate for Payer: Galaxy Health WC |
$1,936.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,446.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,344.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.72
|
| Rate for Payer: Multiplan Commercial |
$1,822.40
|
| Rate for Payer: Networks By Design Commercial |
$1,480.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.30
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
OP
|
$2,278.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$455.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cigna of CA HMO |
$1,457.92
|
| Rate for Payer: Cigna of CA PPO |
$1,685.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,594.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,936.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,446.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,822.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,480.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.30
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,366.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,139.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,139.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,139.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,139.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
IP
|
$2,278.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$455.60 |
| Max. Negotiated Rate |
$1,936.30 |
| Rate for Payer: Adventist Health Commercial |
$455.60
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,594.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.20
|
| Rate for Payer: EPIC Health Plan Senior |
$911.20
|
| Rate for Payer: Galaxy Health WC |
$1,936.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,446.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,344.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.72
|
| Rate for Payer: Multiplan Commercial |
$1,822.40
|
| Rate for Payer: Networks By Design Commercial |
$1,480.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,936.30
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
OP
|
$3,686.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$737.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,658.70
|
| Rate for Payer: Cash Price |
$1,658.70
|
| Rate for Payer: Cash Price |
$1,658.70
|
| Rate for Payer: Cigna of CA HMO |
$2,359.04
|
| Rate for Payer: Cigna of CA PPO |
$2,727.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,580.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$3,133.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,211.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,340.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$2,948.80
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$2,395.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,133.10
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,211.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,843.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,843.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,843.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
IP
|
$3,686.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.20 |
| Max. Negotiated Rate |
$3,133.10 |
| Rate for Payer: Adventist Health Commercial |
$737.20
|
| Rate for Payer: Cash Price |
$1,658.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,580.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,474.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,474.40
|
| Rate for Payer: Galaxy Health WC |
$3,133.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,211.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,340.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,174.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.64
|
| Rate for Payer: Multiplan Commercial |
$2,948.80
|
| Rate for Payer: Networks By Design Commercial |
$2,395.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,133.10
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$1,414.40 |
| Rate for Payer: Adventist Health Commercial |
$332.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.60
|
| Rate for Payer: EPIC Health Plan Senior |
$665.60
|
| Rate for Payer: Galaxy Health WC |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,056.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$981.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$132.98 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$682.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$343.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna of CA HMO |
$1,064.96
|
| Rate for Payer: Cigna of CA PPO |
$1,231.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,056.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$998.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$998.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$1,414.40 |
| Rate for Payer: Adventist Health Commercial |
$332.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.60
|
| Rate for Payer: EPIC Health Plan Senior |
$665.60
|
| Rate for Payer: Galaxy Health WC |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,056.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$981.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$1,414.40 |
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Adventist Health Commercial |
$332.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.60
|
| Rate for Payer: EPIC Health Plan Senior |
$665.60
|
| Rate for Payer: Galaxy Health WC |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,056.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$981.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.58 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$332.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna of CA HMO |
$1,064.96
|
| Rate for Payer: Cigna of CA PPO |
$1,231.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,056.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$1,414.40 |
| Rate for Payer: Adventist Health Commercial |
$332.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.60
|
| Rate for Payer: EPIC Health Plan Senior |
$665.60
|
| Rate for Payer: Galaxy Health WC |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,056.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$981.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.98 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Cigna of CA PPO |
$1,231.36
|
| Rate for Payer: Adventist Health Commercial |
$332.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna of CA HMO |
$1,064.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,056.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.00
|
| Rate for Payer: United Healthcare All Other HMO |
$832.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$832.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.58 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$332.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$343.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna of CA HMO |
$1,064.96
|
| Rate for Payer: Cigna of CA PPO |
$1,231.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,414.40
|
| Rate for Payer: Global Benefits Group Commercial |
$998.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,056.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Networks By Design Commercial |
$1,081.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,414.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$998.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$998.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.00
|
| Rate for Payer: United Healthcare All Other HMO |
$832.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$832.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
IP
|
$1,658.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.60 |
| Max. Negotiated Rate |
$1,409.30 |
| Rate for Payer: Adventist Health Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,160.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$663.20
|
| Rate for Payer: EPIC Health Plan Senior |
$663.20
|
| Rate for Payer: Galaxy Health WC |
$1,409.30
|
| Rate for Payer: Global Benefits Group Commercial |
$994.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,052.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$978.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.92
|
| Rate for Payer: Multiplan Commercial |
$1,326.40
|
| Rate for Payer: Networks By Design Commercial |
$1,077.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,409.30
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
OP
|
$1,658.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$679.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$407.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cigna of CA HMO |
$1,061.12
|
| Rate for Payer: Cigna of CA PPO |
$1,226.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,160.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,409.30
|
| Rate for Payer: Global Benefits Group Commercial |
$994.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,052.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,326.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,077.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,409.30
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$994.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$994.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
OP
|
$1,658.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Cigna of CA HMO |
$1,061.12
|
| Rate for Payer: Cigna of CA PPO |
$1,226.92
|
| Rate for Payer: Adventist Health Commercial |
$331.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,160.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,409.30
|
| Rate for Payer: Global Benefits Group Commercial |
$994.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,052.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,326.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,077.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,409.30
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$994.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.00
|
| Rate for Payer: United Healthcare All Other HMO |
$829.00
|
| Rate for Payer: United Healthcare HMO Rider |
$829.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$829.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
IP
|
$1,658.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$331.60 |
| Max. Negotiated Rate |
$1,409.30 |
| Rate for Payer: Adventist Health Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$746.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,160.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$663.20
|
| Rate for Payer: EPIC Health Plan Senior |
$663.20
|
| Rate for Payer: Galaxy Health WC |
$1,409.30
|
| Rate for Payer: Global Benefits Group Commercial |
$994.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,052.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$978.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.92
|
| Rate for Payer: Multiplan Commercial |
$1,326.40
|
| Rate for Payer: Networks By Design Commercial |
$1,077.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,409.30
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
IP
|
$2,801.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.20 |
| Max. Negotiated Rate |
$2,380.85 |
| Rate for Payer: Adventist Health Commercial |
$560.20
|
| Rate for Payer: Cash Price |
$1,260.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,960.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,120.40
|
| Rate for Payer: Galaxy Health WC |
$2,380.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,680.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,778.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,652.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.24
|
| Rate for Payer: Multiplan Commercial |
$2,240.80
|
| Rate for Payer: Networks By Design Commercial |
$1,820.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,380.85
|
|
