|
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
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,279.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,673.05
|
| 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: TriValley Medical Group Commercial/Senior |
$1,872.00
|
| 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 |
$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 2.6-7.5CM
|
Facility
|
IP
|
$1,706.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$341.20 |
| Max. Negotiated Rate |
$1,450.10 |
| Rate for Payer: Adventist Health Commercial |
$341.20
|
| Rate for Payer: Cash Price |
$767.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,194.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.40
|
| Rate for Payer: EPIC Health Plan Senior |
$682.40
|
| Rate for Payer: Galaxy Health WC |
$1,450.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,083.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,006.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.44
|
| Rate for Payer: Multiplan Commercial |
$1,364.80
|
| Rate for Payer: Networks By Design Commercial |
$1,108.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.10
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
IP
|
$1,706.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.20 |
| Max. Negotiated Rate |
$1,450.10 |
| Rate for Payer: Adventist Health Commercial |
$341.20
|
| Rate for Payer: Cash Price |
$767.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,194.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.40
|
| Rate for Payer: EPIC Health Plan Senior |
$682.40
|
| Rate for Payer: Galaxy Health WC |
$1,450.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,083.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,006.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.44
|
| Rate for Payer: Multiplan Commercial |
$1,364.80
|
| Rate for Payer: Networks By Design Commercial |
$1,108.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.10
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
OP
|
$1,706.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$699.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,244.03
|
| 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 |
$767.70
|
| Rate for Payer: Cash Price |
$767.70
|
| Rate for Payer: Cash Price |
$767.70
|
| Rate for Payer: Cigna of CA HMO |
$1,091.84
|
| Rate for Payer: Cigna of CA PPO |
$1,262.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,194.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,450.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.60
|
| Rate for Payer: Heritage Provider Network Commercial/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 |
$1,083.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.44
|
| 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 |
$1,364.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,108.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,023.60
|
| 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 2.6-7.5CM
|
Facility
|
OP
|
$1,706.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Adventist Health Commercial |
$341.20
|
| 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 |
$767.70
|
| Rate for Payer: Cash Price |
$767.70
|
| Rate for Payer: Cash Price |
$767.70
|
| Rate for Payer: Cigna of CA HMO |
$1,091.84
|
| Rate for Payer: Cigna of CA PPO |
$1,262.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,194.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,450.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.60
|
| Rate for Payer: Heritage Provider Network Commercial/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 |
$1,083.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.44
|
| 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 |
$1,364.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,108.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$853.00
|
| Rate for Payer: United Healthcare All Other HMO |
$853.00
|
| Rate for Payer: United Healthcare HMO Rider |
$853.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$853.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 7.6-12.5 CM
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$2,040.00 |
| 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: Adventist Health Commercial |
$480.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,680.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,440.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,524.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,416.00
|
| 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
|
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 |
$1,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,680.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,524.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,416.00
|
| 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
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$984.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,276.15
|
| 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 |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| 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 |
$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 |
$1,680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,040.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,440.00
|
| 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 |
$1,524.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$589.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.00
|
| 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 |
$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: TriValley Medical Group Commercial/Senior |
$1,440.00
|
| 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 |
$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 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$480.00
|
| 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 |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| 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 |
$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 |
$1,680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,040.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,440.00
|
| 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 |
$1,524.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$589.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.00
|
| 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 |
$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 |
$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 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 |
$1,577.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,454.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,226.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,068.54
|
| 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 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$701.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,577.70
|
| Rate for Payer: Cash Price |
$1,577.70
|
| Rate for Payer: Cash Price |
$1,577.70
|
| 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 |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,454.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| 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/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,226.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| 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 |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
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
|
456
|
| Min. Negotiated Rate |
$427.00 |
| Max. Negotiated Rate |
$1,814.75 |
| Rate for Payer: Adventist Health Commercial |
$427.00
|
| Rate for Payer: Cash Price |
$960.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,494.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,355.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,259.65
|
| 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
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$875.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,152.12
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$960.75
|
| Rate for Payer: Cash Price |
$960.75
|
| Rate for Payer: Cash Price |
$960.75
|
| 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 |
$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 |
$1,494.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/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 |
$1,355.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.40
|
| 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 |
$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: TriValley Medical Group Commercial/Senior |
$1,281.00
|
| 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 |
$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 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: 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 Foundation Hospitals Commercial/Self Funded |
$1,355.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,259.65
|
| 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
|
| Rate for Payer: Adventist Health Commercial |
$427.00
|
| Rate for Payer: Cash Price |
$960.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,494.50
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$427.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$960.75
|
| Rate for Payer: Cash Price |
$960.75
|
| Rate for Payer: Cash Price |
$960.75
|
| 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 |
$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 |
$1,494.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/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 |
$1,355.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.40
|
| 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 |
$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 |
$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 LT 2.5 CM SCALP
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$584.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,021.49
|
| 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 |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| 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 |
$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 |
$997.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/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 |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$467.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$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: TriValley Medical Group Commercial/Senior |
$855.00
|
| 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 |
$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 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 |
$641.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$997.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$840.75
|
| 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 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| 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 |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| 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 |
$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 |
$997.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/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 |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$467.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$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 |
$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 LT 2.5 CM SCALP
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$997.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$840.75
|
| 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
|
OP
|
$2,004.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
900501416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.43 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$400.80
|
| 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 |
$901.80
|
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cash Price |
$901.80
|
| 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 |
$1,425.86
|
| 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 |
$1,402.80
|
| 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 |
$1,703.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,202.40
|
| 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 |
$1,272.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.96
|
| 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 |
$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 |
$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 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 |
$901.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,402.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,272.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,182.36
|
| 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
|
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 |
$1,268.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,973.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,790.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,663.21
|
| 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 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 |
$522.85 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$563.80
|
| 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 |
$1,268.55
|
| Rate for Payer: Cash Price |
$1,268.55
|
| Rate for Payer: Cash Price |
$1,268.55
|
| 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 |
$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 |
$1,973.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,396.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,691.40
|
| 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 |
$1,790.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.56
|
| 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 |
$2,255.20
|
| 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 |
$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 WNDS 12.6-20.0 CM
|
Facility
|
OP
|
$2,819.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,155.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,681.18
|
| 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 |
$1,268.55
|
| Rate for Payer: Cash Price |
$1,268.55
|
| Rate for Payer: Cash Price |
$1,268.55
|
| 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 |
$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 |
$1,973.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,396.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,691.40
|
| 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 |
$1,790.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.56
|
| 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 |
$2,255.20
|
| 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: TriValley Medical Group Commercial/Senior |
$1,691.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 WNDS 12.6-20.0 CM
|
Facility
|
IP
|
$2,819.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$563.80 |
| Max. Negotiated Rate |
$2,396.15 |
| Rate for Payer: Adventist Health Commercial |
$563.80
|
| Rate for Payer: Cash Price |
$1,268.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,973.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,790.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,663.21
|
| 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
|
|
