|
HC LARYNGOSCOPY INDIRECT
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$339.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$307.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.15
|
| 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 INDIRECT
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$198.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$318.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cash Price |
$218.25
|
| 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 |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$339.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.60
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$421.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$307.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$275.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$323.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$344.02
|
| 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: TriValley Medical Group Commercial/Senior |
$291.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$256.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$503.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| 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 |
$754.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$553.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$503.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.02
|
| Rate for Payer: EPIC Health Plan Senior |
$553.34
|
| 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/Senior |
$824.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$503.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$540.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$633.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.07
|
| 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 |
$503.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Vantage Medical Group Senior |
$503.04
|
|
|
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 |
$1,004.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.88
|
| 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
|
IP
|
$10,243.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
456
|
| 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 |
$4,609.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,170.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,504.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,043.37
|
| 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 LARYNGOSCOPY W/TUMOR EXC W/SCO
|
Facility
|
OP
|
$10,243.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$8,706.55 |
| Rate for Payer: Galaxy Health WC |
$8,706.55
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Adventist Health Commercial |
$4,199.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,700.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$4,609.35
|
| Rate for Payer: Cash Price |
$4,609.35
|
| Rate for Payer: Cash Price |
$4,609.35
|
| 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 |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: Global Benefits Group Commercial |
$6,145.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,504.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$509.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,154.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,458.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,042.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,425.68
|
| 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: TriValley Medical Group Commercial/Senior |
$6,145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
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 |
$4,609.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,170.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,504.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,043.37
|
| 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 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 |
$8,706.55 |
| Rate for Payer: Adventist Health Commercial |
$2,048.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$4,609.35
|
| Rate for Payer: Cash Price |
$4,609.35
|
| Rate for Payer: Cash Price |
$4,609.35
|
| 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 |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| 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/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,504.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$509.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,154.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,458.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,042.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,425.68
|
| 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 |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
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 |
$3,044.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,736.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,296.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,991.94
|
| 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 LASER TREATMENT
|
Facility
|
OP
|
$6,766.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$7,912.21 |
| Rate for Payer: Galaxy Health WC |
$5,751.10
|
| Rate for Payer: Adventist Health Commercial |
$1,353.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,603.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$3,044.70
|
| Rate for Payer: Cash Price |
$3,044.70
|
| Rate for Payer: Cash Price |
$3,044.70
|
| Rate for Payer: Cash Price |
$3,044.70
|
| 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 |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,736.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,296.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,042.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,425.68
|
| 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 |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
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 |
$1,736.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,700.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,449.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,276.22
|
| 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 |
$2,140.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,475.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,461.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,624.22
|
| Rate for Payer: Cash Price |
$1,736.10
|
| Rate for Payer: Cash Price |
$1,736.10
|
| 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 |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,700.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| 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/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$306.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,449.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$925.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| 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 |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$4,807.80
|
| Rate for Payer: Cash Price |
$4,807.80
|
| Rate for Payer: Cash Price |
$4,807.80
|
| 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 |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,013.60
|
| 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/Senior |
$7,474.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,784.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,041.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,899.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,564.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,742.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,107.48
|
| 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 |
$4,557.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
|
|
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 |
$4,807.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,478.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,784.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,303.56
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| 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 |
$263.25
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| 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 |
$263.25
|
| 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
|
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 |
$245.15
|
| Rate for Payer: Blue Shield of California Commercial |
$311.44
|
| Rate for Payer: Blue Shield of California Commercial |
$205.34
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| 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 |
$245.15
|
| Rate for Payer: Blue Shield of California Commercial |
$311.44
|
| Rate for Payer: Blue Shield of California Commercial |
$205.34
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| 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 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
|
456
|
| Min. Negotiated Rate |
$567.40 |
| Max. Negotiated Rate |
$2,411.45 |
| Rate for Payer: Adventist Health Commercial |
$567.40
|
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,985.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,801.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,673.83
|
| 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 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 |
$1,276.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,985.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,801.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,673.83
|
| 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 12.6-20.0 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$215.04 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,163.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,469.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: Cash Price |
$1,276.65
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,985.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,801.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$680.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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: TriValley Medical Group Commercial/Senior |
$1,702.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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 |
$6,716.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,801.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$680.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
| Rate for Payer: Adventist Health Commercial |
$567.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: Cash Price |
$1,276.65
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,985.90
|
|
|
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
|
456
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,652.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,184.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,981.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,840.80
|
| 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| 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 |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| 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/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,981.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$752.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,273.76
|
| 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 |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
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 |
$1,404.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,184.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,981.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,840.80
|
| 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
|
|
