|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$450.50 |
| Rate for Payer: Adventist Health Commercial |
$106.00
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.00
|
| Rate for Payer: EPIC Health Plan Senior |
$212.00
|
| Rate for Payer: Galaxy Health WC |
$450.50
|
| Rate for Payer: Global Benefits Group Commercial |
$318.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$328.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.20
|
| Rate for Payer: Multiplan Commercial |
$424.00
|
| Rate for Payer: Networks By Design Commercial |
$344.50
|
| Rate for Payer: Prime Health Services Commercial |
$450.50
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$106.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cigna of CA HMO |
$339.20
|
| Rate for Payer: Cigna of CA PPO |
$392.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$450.50
|
| Rate for Payer: Global Benefits Group Commercial |
$318.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| Rate for Payer: Multiplan Commercial |
$424.00
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$344.50
|
| Rate for Payer: Prime Health Services Commercial |
$450.50
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$106.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cigna of CA HMO |
$339.20
|
| Rate for Payer: Cigna of CA PPO |
$392.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$450.50
|
| Rate for Payer: Global Benefits Group Commercial |
$318.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| Rate for Payer: Multiplan Commercial |
$424.00
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$344.50
|
| Rate for Payer: Prime Health Services Commercial |
$450.50
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$265.00
|
| Rate for Payer: United Healthcare All Other HMO |
$265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$265.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$265.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC LARYNGOSCOPY INDIRECT
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$266.75
|
| Rate for Payer: Cash Price |
$266.75
|
| Rate for Payer: Cash Price |
$266.75
|
| Rate for Payer: Cigna of CA HMO |
$310.40
|
| Rate for Payer: Cigna of CA PPO |
$358.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.50
|
| Rate for Payer: United Healthcare All Other HMO |
$242.50
|
| Rate for Payer: United Healthcare HMO Rider |
$242.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$242.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC LARYNGOSCOPY INDIRECT
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Cash Price |
$266.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Senior |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
|
|
HC LARYNGOSCOPY W/RMVL F.B.
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
900501549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$740.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$493.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$666.08
|
| Rate for Payer: EPIC Health Plan Senior |
$493.39
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$809.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$493.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$621.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$661.14
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Multiplan WC |
$786.13
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Prime Health Services WC |
$778.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,116.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$493.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$740.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.73
|
| Rate for Payer: Vantage Medical Group Senior |
$493.39
|
|
|
HC LARYNGOSCOPY W/RMVL F.B.
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
900501549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,381.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
|
|
HC LARYNGOSCOPY W/TUMOR EXC W/SCO
|
Facility
|
OP
|
$10,243.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.31 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$2,048.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,684.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$5,633.65
|
| Rate for Payer: Cash Price |
$5,633.65
|
| Rate for Payer: Cash Price |
$5,633.65
|
| Rate for Payer: Cigna of CA HMO |
$6,555.52
|
| Rate for Payer: Cigna of CA PPO |
$7,579.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,153.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,324.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4,684.64
|
| Rate for Payer: Galaxy Health WC |
$8,706.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,145.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,682.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,684.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,832.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,684.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,458.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,902.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,277.42
|
| Rate for Payer: Multiplan Commercial |
$8,194.40
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Networks By Design Commercial |
$6,657.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,706.55
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,121.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,121.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,121.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,121.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,684.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,684.64
|
|
|
HC LARYNGOSCOPY W/TUMOR EXC W/SCO
|
Facility
|
IP
|
$10,243.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,048.60 |
| Max. Negotiated Rate |
$8,706.55 |
| Rate for Payer: Adventist Health Commercial |
$2,048.60
|
| Rate for Payer: Cash Price |
$5,633.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,097.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,097.20
|
| Rate for Payer: Galaxy Health WC |
$8,706.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,832.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,902.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,340.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,458.32
|
| Rate for Payer: Multiplan Commercial |
$8,194.40
|
| Rate for Payer: Networks By Design Commercial |
$6,657.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,706.55
|
|
|
HC LASER TREATMENT
|
Facility
|
OP
|
$6,766.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$7,682.81 |
| Rate for Payer: Adventist Health Commercial |
$1,353.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,684.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$3,721.30
|
| Rate for Payer: Cash Price |
$3,721.30
|
| Rate for Payer: Cash Price |
$3,721.30
|
| Rate for Payer: Cigna of CA HMO |
$4,330.24
|
| Rate for Payer: Cigna of CA PPO |
$5,006.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,153.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,324.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4,684.64
|
| Rate for Payer: Galaxy Health WC |
$5,751.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,682.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,684.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,512.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,684.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,902.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,277.42
|
| Rate for Payer: Multiplan Commercial |
$5,412.80
|
| Rate for Payer: Networks By Design Commercial |
$4,397.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,751.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,059.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,059.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,684.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,684.64
|
|
|
HC LASER TREATMENT
|
Facility
|
IP
|
$6,766.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,353.20 |
| Max. Negotiated Rate |
$5,751.10 |
| Rate for Payer: Adventist Health Commercial |
$1,353.20
|
| Rate for Payer: Cash Price |
$3,721.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,706.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,706.40
|
| Rate for Payer: Galaxy Health WC |
$5,751.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,512.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,577.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,188.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.84
|
| Rate for Payer: Multiplan Commercial |
$5,412.80
|
| Rate for Payer: Networks By Design Commercial |
$4,397.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,751.10
|
|
|
HC LASIX RENOGRAM
|
Facility
|
IP
|
$3,858.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$771.60 |
| Max. Negotiated Rate |
$3,279.30 |
| Rate for Payer: Adventist Health Commercial |
$771.60
|
| Rate for Payer: Cash Price |
$2,121.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,543.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,543.20
|
| Rate for Payer: Galaxy Health WC |
$3,279.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,314.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,573.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,469.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,388.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$925.92
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: Networks By Design Commercial |
$2,507.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,279.30
|
|
|
HC LASIX RENOGRAM
|
Facility
|
OP
|
$3,858.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$306.82 |
| Max. Negotiated Rate |
$3,279.30 |
| Rate for Payer: Adventist Health Commercial |
$771.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,530.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,369.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,361.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,558.63
|
| Rate for Payer: Cash Price |
$2,121.90
|
| Rate for Payer: Cash Price |
$2,121.90
|
| Rate for Payer: Cigna of CA HMO |
$2,469.12
|
| Rate for Payer: Cigna of CA PPO |
$2,854.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$3,279.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,314.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$306.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,573.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$925.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: Networks By Design Commercial |
$2,507.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,279.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,314.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,314.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
IP
|
$10,684.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,136.80 |
| Max. Negotiated Rate |
$9,081.40 |
| Rate for Payer: Adventist Health Commercial |
$2,136.80
|
| Rate for Payer: Cash Price |
$5,876.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,273.60
|
| Rate for Payer: Galaxy Health WC |
$9,081.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,410.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,070.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,613.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,564.16
|
| Rate for Payer: Multiplan Commercial |
$8,547.20
|
| Rate for Payer: Networks By Design Commercial |
$6,944.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,081.40
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
OP
|
$10,684.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$9,081.40 |
| Rate for Payer: Adventist Health Commercial |
$2,136.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,876.20
|
| Rate for Payer: Cash Price |
$5,876.20
|
| Rate for Payer: Cash Price |
$5,876.20
|
| Rate for Payer: Cigna of CA HMO |
$6,837.76
|
| Rate for Payer: Cigna of CA PPO |
$7,906.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$9,081.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,410.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,041.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,564.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$8,547.20
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$6,944.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,081.40
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,342.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,342.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,342.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,342.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC LAT SUPPORT UPRIGHTS ADD LE
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L2680
|
| Hospital Charge Code |
915352680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.58
|
| Rate for Payer: Blue Shield of California Commercial |
$298.89
|
| Rate for Payer: Blue Shield of California EPN |
$196.83
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| 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 |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC LAT SUPPORT UPRIGHTS ADD LE
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L2680
|
| Hospital Charge Code |
905352680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.58
|
| Rate for Payer: Blue Shield of California Commercial |
$298.89
|
| Rate for Payer: Blue Shield of California EPN |
$196.83
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| 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 |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC LAT SUPPORT UPRIGHTS ADD LE
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L2680
|
| Hospital Charge Code |
905352680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC LAT SUPPORT UPRIGHTS ADD LE
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L2680
|
| Hospital Charge Code |
915352680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cash Price |
$222.75
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.04 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$567.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,560.35
|
| Rate for Payer: Cash Price |
$1,560.35
|
| Rate for Payer: Cash Price |
$1,560.35
|
| Rate for Payer: Cigna of CA HMO |
$1,815.68
|
| Rate for Payer: Cigna of CA PPO |
$2,099.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,411.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$680.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,269.60
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,844.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,411.45
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,702.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,418.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,418.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,418.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,418.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
IP
|
$2,837.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$567.40 |
| Max. Negotiated Rate |
$2,411.45 |
| Rate for Payer: Adventist Health Commercial |
$567.40
|
| Rate for Payer: Cash Price |
$1,560.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,134.80
|
| Rate for Payer: Galaxy Health WC |
$2,411.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,080.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,756.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$680.88
|
| Rate for Payer: Multiplan Commercial |
$2,269.60
|
| Rate for Payer: Networks By Design Commercial |
$1,844.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,411.45
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
IP
|
$3,120.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,652.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,931.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: Networks By Design Commercial |
$2,028.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
OP
|
$3,120.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna of CA HMO |
$1,996.80
|
| Rate for Payer: Cigna of CA PPO |
$2,308.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$752.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$2,028.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,560.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
IP
|
$1,706.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.20 |
| Max. Negotiated Rate |
$1,450.10 |
| Rate for Payer: Adventist Health Commercial |
$341.20
|
| Rate for Payer: Cash Price |
$938.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.40
|
| Rate for Payer: EPIC Health Plan Senior |
$682.40
|
| Rate for Payer: Galaxy Health WC |
$1,450.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,137.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$649.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,056.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.44
|
| Rate for Payer: Multiplan Commercial |
$1,364.80
|
| Rate for Payer: Networks By Design Commercial |
$1,108.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.10
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
OP
|
$1,706.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$341.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$938.30
|
| Rate for Payer: Cash Price |
$938.30
|
| Rate for Payer: Cash Price |
$938.30
|
| Rate for Payer: Cigna of CA HMO |
$1,091.84
|
| Rate for Payer: Cigna of CA PPO |
$1,262.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,450.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,137.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,364.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,108.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$853.00
|
| Rate for Payer: United Healthcare All Other HMO |
$853.00
|
| Rate for Payer: United Healthcare HMO Rider |
$853.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$853.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
