|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Adventist Health Commercial |
$480.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$960.00
|
| Rate for Payer: Galaxy Health WC |
$2,040.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,440.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,600.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$914.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,485.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.00
|
| Rate for Payer: Multiplan Commercial |
$1,920.00
|
| Rate for Payer: Networks By Design Commercial |
$1,560.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,040.00
|
|
|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$480.00
|
| 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 |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna of CA HMO |
$1,536.00
|
| Rate for Payer: Cigna of CA PPO |
$1,776.00
|
| 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 |
$2,040.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,440.00
|
| 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 |
$1,600.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.00
|
| 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 |
$1,920.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,560.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,040.00
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,200.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,200.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,200.00
|
| 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
|
|
|
HC LAY CLOS OF WND GT 30.0 CM
|
Facility
|
OP
|
$3,506.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
900501643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$701.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$701.20
|
| 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 |
$1,928.30
|
| Rate for Payer: Cash Price |
$1,928.30
|
| Rate for Payer: Cash Price |
$1,928.30
|
| Rate for Payer: Cigna of CA HMO |
$2,243.84
|
| Rate for Payer: Cigna of CA PPO |
$2,594.44
|
| 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 |
$2,980.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,103.60
|
| 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 |
$2,338.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.44
|
| 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 |
$2,804.80
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,278.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,980.10
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,103.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,753.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,753.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,753.00
|
| 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 LAY CLOS OF WND GT 30.0 CM
|
Facility
|
IP
|
$3,506.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
900501643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$701.20 |
| Max. Negotiated Rate |
$2,980.10 |
| Rate for Payer: Adventist Health Commercial |
$701.20
|
| Rate for Payer: Cash Price |
$1,928.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,402.40
|
| Rate for Payer: Galaxy Health WC |
$2,980.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,103.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,338.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,335.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,170.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.44
|
| Rate for Payer: Multiplan Commercial |
$2,804.80
|
| Rate for Payer: Networks By Design Commercial |
$2,278.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,980.10
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
IP
|
$2,135.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.00 |
| Max. Negotiated Rate |
$1,814.75 |
| Rate for Payer: Adventist Health Commercial |
$427.00
|
| Rate for Payer: Cash Price |
$1,174.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$854.00
|
| Rate for Payer: EPIC Health Plan Senior |
$854.00
|
| Rate for Payer: Galaxy Health WC |
$1,814.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,281.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,424.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,321.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.40
|
| Rate for Payer: Multiplan Commercial |
$1,708.00
|
| Rate for Payer: Networks By Design Commercial |
$1,387.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,814.75
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
OP
|
$2,135.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$427.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,174.25
|
| Rate for Payer: Cash Price |
$1,174.25
|
| Rate for Payer: Cash Price |
$1,174.25
|
| Rate for Payer: Cigna of CA HMO |
$1,366.40
|
| Rate for Payer: Cigna of CA PPO |
$1,579.90
|
| 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 |
$1,814.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,281.00
|
| 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 |
$1,424.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.40
|
| 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 |
$1,708.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,387.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,814.75
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,281.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,067.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,067.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,067.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,067.50
|
| 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 LT 2.5 CM SCALP
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| 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 |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cigna of CA HMO |
$912.00
|
| Rate for Payer: Cigna of CA PPO |
$1,054.50
|
| 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 |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| 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 |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,140.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$855.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$712.50
|
| Rate for Payer: United Healthcare All Other HMO |
$712.50
|
| Rate for Payer: United Healthcare HMO Rider |
$712.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$712.50
|
| 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 LT 2.5 CM SCALP
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$570.00
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
|
|
HC LAY CLOS OF WNDS 12.6- 20.0 CM
|
Facility
|
IP
|
$2,004.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
900501416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.80 |
| Max. Negotiated Rate |
$1,703.40 |
| Rate for Payer: Adventist Health Commercial |
$400.80
|
| Rate for Payer: Cash Price |
$1,102.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.60
|
| Rate for Payer: EPIC Health Plan Senior |
$801.60
|
| Rate for Payer: Galaxy Health WC |
$1,703.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,202.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,240.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.96
|
| Rate for Payer: Multiplan Commercial |
$1,603.20
|
| Rate for Payer: Networks By Design Commercial |
$1,302.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,703.40
|
|
|
HC LAY CLOS OF WNDS 12.6- 20.0 CM
|
Facility
|
OP
|
$2,004.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
900501416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.43 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$400.80
|
| 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 |
$1,102.20
|
| Rate for Payer: Cash Price |
$1,102.20
|
| Rate for Payer: Cash Price |
$1,102.20
|
| Rate for Payer: Cigna of CA HMO |
$1,282.56
|
| Rate for Payer: Cigna of CA PPO |
$1,482.96
|
| 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 |
$1,703.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,202.40
|
| 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 |
$1,336.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.96
|
| 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 |
$1,603.20
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,302.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,703.40
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,202.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,002.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,002.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,002.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,002.00
|
| 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 WNDS 12.6-20.0 CM
|
Facility
|
OP
|
$2,819.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$507.64 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$563.80
|
| 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 |
$1,550.45
|
| Rate for Payer: Cash Price |
$1,550.45
|
| Rate for Payer: Cash Price |
$1,550.45
|
| Rate for Payer: Cigna of CA HMO |
$1,804.16
|
| Rate for Payer: Cigna of CA PPO |
$2,086.06
|
| 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 |
$2,396.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,691.40
|
| 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 |
$1,880.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.56
|
| 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 |
$2,255.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,832.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,396.15
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,691.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,409.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,409.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,409.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,409.50
|
| 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 WNDS 12.6-20.0 CM
|
Facility
|
IP
|
$2,819.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$563.80 |
| Max. Negotiated Rate |
$2,396.15 |
| Rate for Payer: Adventist Health Commercial |
$563.80
|
| Rate for Payer: Cash Price |
$1,550.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,127.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,127.60
|
| Rate for Payer: Galaxy Health WC |
$2,396.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,691.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,880.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,744.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.56
|
| Rate for Payer: Multiplan Commercial |
$2,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,832.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,396.15
|
|
|
HC LAY CLOS OF WNDS 20.1-30.0 CM
|
Facility
|
IP
|
$2,574.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
900501525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$514.80 |
| Max. Negotiated Rate |
$2,187.90 |
| Rate for Payer: Adventist Health Commercial |
$514.80
|
| Rate for Payer: Cash Price |
$1,415.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.60
|
| Rate for Payer: Galaxy Health WC |
$2,187.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,544.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,716.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$980.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,593.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.76
|
| Rate for Payer: Multiplan Commercial |
$2,059.20
|
| Rate for Payer: Networks By Design Commercial |
$1,673.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.90
|
|
|
HC LAY CLOS OF WNDS 20.1-30.0 CM
|
Facility
|
OP
|
$2,574.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
900501525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$507.64 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$514.80
|
| 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 |
$1,415.70
|
| Rate for Payer: Cash Price |
$1,415.70
|
| Rate for Payer: Cash Price |
$1,415.70
|
| Rate for Payer: Cigna of CA HMO |
$1,647.36
|
| Rate for Payer: Cigna of CA PPO |
$1,904.76
|
| 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 |
$2,187.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,544.40
|
| 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 |
$1,716.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.76
|
| 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 |
$2,059.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,673.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.90
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,544.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,287.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,287.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,287.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.00
|
| 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
|
|
|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
OP
|
$2,434.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$486.80
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,338.70
|
| Rate for Payer: Cash Price |
$1,338.70
|
| Rate for Payer: Cash Price |
$1,338.70
|
| Rate for Payer: Cigna of CA HMO |
$1,557.76
|
| Rate for Payer: Cigna of CA PPO |
$1,801.16
|
| 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 |
$2,068.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,460.40
|
| 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 |
$1,623.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.16
|
| 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 |
$1,947.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,582.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.90
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,460.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,217.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,217.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.00
|
| 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
|
|
|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
IP
|
$2,434.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$486.80 |
| Max. Negotiated Rate |
$2,068.90 |
| Rate for Payer: Adventist Health Commercial |
$486.80
|
| Rate for Payer: Cash Price |
$1,338.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$973.60
|
| Rate for Payer: EPIC Health Plan Senior |
$973.60
|
| Rate for Payer: Galaxy Health WC |
$2,068.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,460.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,623.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,506.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.16
|
| Rate for Payer: Multiplan Commercial |
$1,947.20
|
| Rate for Payer: Networks By Design Commercial |
$1,582.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.90
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$1,432.25 |
| Rate for Payer: Adventist Health Commercial |
$337.00
|
| Rate for Payer: Cash Price |
$926.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.00
|
| Rate for Payer: EPIC Health Plan Senior |
$674.00
|
| Rate for Payer: Galaxy Health WC |
$1,432.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,011.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,123.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,043.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.40
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: Networks By Design Commercial |
$1,095.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,432.25
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.58 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$337.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$926.75
|
| Rate for Payer: Cash Price |
$926.75
|
| Rate for Payer: Cash Price |
$926.75
|
| Rate for Payer: Cigna of CA HMO |
$1,078.40
|
| Rate for Payer: Cigna of CA PPO |
$1,246.90
|
| 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 |
$1,432.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,011.00
|
| 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 |
$1,123.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.40
|
| 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 |
$1,348.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,095.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,432.25
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,011.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$842.50
|
| Rate for Payer: United Healthcare All Other HMO |
$842.50
|
| Rate for Payer: United Healthcare HMO Rider |
$842.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.50
|
| 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 WNDS 5.1-7.5 CM
|
Facility
|
IP
|
$2,556.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$2,172.60 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,022.40
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,704.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$973.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,582.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.44
|
| Rate for Payer: Multiplan Commercial |
$2,044.80
|
| Rate for Payer: Networks By Design Commercial |
$1,661.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
OP
|
$2,556.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$507.64 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| 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 |
$1,405.80
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: Cigna of CA HMO |
$1,635.84
|
| Rate for Payer: Cigna of CA PPO |
$1,891.44
|
| 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 |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| 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 |
$1,704.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.44
|
| 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 |
$2,044.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,661.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,533.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,278.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,278.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,278.00
|
| 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
|
|
|
HC LAY CLOS OF WNDS GT 30.0 CM
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$507.64 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| 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 |
$1,846.90
|
| Rate for Payer: Cash Price |
$1,846.90
|
| Rate for Payer: Cash Price |
$1,846.90
|
| Rate for Payer: Cigna of CA HMO |
$2,149.12
|
| Rate for Payer: Cigna of CA PPO |
$2,484.92
|
| 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 |
$2,854.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| 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 |
$2,239.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.92
|
| 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 |
$2,686.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,014.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,679.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,679.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,679.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,679.00
|
| 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
|
|
|
HC LAY CLOS OF WNDS GT 30.0 CM
|
Facility
|
IP
|
$3,358.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$671.60 |
| Max. Negotiated Rate |
$2,854.30 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| Rate for Payer: Cash Price |
$1,846.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,343.20
|
| Rate for Payer: Galaxy Health WC |
$2,854.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,239.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,279.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,078.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.92
|
| Rate for Payer: Multiplan Commercial |
$2,686.40
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$1,230.80 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| Rate for Payer: Cash Price |
$796.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.20
|
| Rate for Payer: EPIC Health Plan Senior |
$579.20
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$965.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$896.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| Rate for Payer: Multiplan Commercial |
$1,158.40
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.26 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$796.40
|
| Rate for Payer: Cash Price |
$796.40
|
| Rate for Payer: Cash Price |
$796.40
|
| Rate for Payer: Cigna of CA HMO |
$926.72
|
| Rate for Payer: Cigna of CA PPO |
$1,071.52
|
| 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 |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| 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 |
$965.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| 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 |
$1,158.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$724.00
|
| Rate for Payer: United Healthcare All Other HMO |
$724.00
|
| Rate for Payer: United Healthcare HMO Rider |
$724.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| 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
|
|
|
HC L&D EA ADD'L 15 MIN
|
Facility
|
IP
|
$952.00
|
|
| Hospital Charge Code |
902400057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$809.20 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$589.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.48
|
| Rate for Payer: Multiplan Commercial |
$761.60
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
