|
HC LAY CLOS OF WNDS 20.1-30.0 CM
|
Facility
|
OP
|
$2,574.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
900501525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$514.80 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$514.80
|
| 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 |
$1,158.30
|
| Rate for Payer: Cash Price |
$1,158.30
|
| Rate for Payer: Cash Price |
$1,158.30
|
| Rate for Payer: Cigna of CA HMO |
$1,647.36
|
| Rate for Payer: Cigna of CA PPO |
$1,904.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,801.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,187.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,544.40
|
| 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 |
$1,634.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$676.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.76
|
| 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 |
$2,059.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,673.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.90
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,544.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,287.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,287.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,287.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 20.1-30.0 CM
|
Facility
|
IP
|
$2,574.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
900501525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$514.80 |
| Max. Negotiated Rate |
$2,187.90 |
| Rate for Payer: Adventist Health Commercial |
$514.80
|
| Rate for Payer: Cash Price |
$1,158.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,801.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.60
|
| Rate for Payer: Galaxy Health WC |
$2,187.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,544.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,634.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,518.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.76
|
| Rate for Payer: Multiplan Commercial |
$2,059.20
|
| Rate for Payer: Networks By Design Commercial |
$1,673.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.90
|
|
|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
OP
|
$2,434.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$997.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,385.57
|
| 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 |
$1,095.30
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cigna of CA HMO |
$1,557.76
|
| Rate for Payer: Cigna of CA PPO |
$1,801.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,068.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,460.40
|
| 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 |
$1,545.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.16
|
| 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 |
$1,947.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,582.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.90
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,460.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,460.40
|
| 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 2.6-5.0 CM
|
Facility
|
OP
|
$2,434.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$486.80
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cigna of CA HMO |
$1,557.76
|
| Rate for Payer: Cigna of CA PPO |
$1,801.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,068.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,460.40
|
| 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 |
$1,545.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.16
|
| 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 |
$1,947.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,582.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.90
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,460.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,217.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,217.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 2.6-5.0 CM
|
Facility
|
IP
|
$2,434.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$486.80 |
| Max. Negotiated Rate |
$2,068.90 |
| Rate for Payer: Adventist Health Commercial |
$486.80
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$973.60
|
| Rate for Payer: EPIC Health Plan Senior |
$973.60
|
| Rate for Payer: Galaxy Health WC |
$2,068.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,460.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,545.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,436.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.16
|
| Rate for Payer: Multiplan Commercial |
$1,947.20
|
| Rate for Payer: Networks By Design Commercial |
$1,582.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.90
|
|
|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
IP
|
$2,434.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$486.80 |
| Max. Negotiated Rate |
$2,068.90 |
| Rate for Payer: Adventist Health Commercial |
$486.80
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$973.60
|
| Rate for Payer: EPIC Health Plan Senior |
$973.60
|
| Rate for Payer: Galaxy Health WC |
$2,068.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,460.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,545.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,436.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.16
|
| Rate for Payer: Multiplan Commercial |
$1,947.20
|
| Rate for Payer: Networks By Design Commercial |
$1,582.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.90
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$1,432.25 |
| Rate for Payer: Adventist Health Commercial |
$337.00
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,179.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.00
|
| Rate for Payer: EPIC Health Plan Senior |
$674.00
|
| Rate for Payer: Galaxy Health WC |
$1,432.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,011.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,069.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.40
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: Networks By Design Commercial |
$1,095.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,432.25
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$1,432.25 |
| Rate for Payer: Adventist Health Commercial |
$337.00
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,179.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.00
|
| Rate for Payer: EPIC Health Plan Senior |
$674.00
|
| Rate for Payer: Galaxy Health WC |
$1,432.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,011.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,069.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.40
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: Networks By Design Commercial |
$1,095.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,432.25
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.58 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$337.00
|
| 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 |
$758.25
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Cigna of CA HMO |
$1,078.40
|
| Rate for Payer: Cigna of CA PPO |
$1,246.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,179.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,432.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,011.00
|
| 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 |
$1,069.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.40
|
| 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 |
$1,348.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,095.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,432.25
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,011.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$842.50
|
| Rate for Payer: United Healthcare All Other HMO |
$842.50
|
| Rate for Payer: United Healthcare HMO Rider |
$842.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 2.6-7.5 CM
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$189.58 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$690.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,260.23
|
| 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 |
$758.25
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Cigna of CA HMO |
$1,078.40
|
| Rate for Payer: Cigna of CA PPO |
$1,246.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,179.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,432.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,011.00
|
| 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 |
$1,069.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.40
|
| 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 |
$1,348.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,095.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,432.25
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,011.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,011.00
|
| 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 WNDS 5.1-7.5 CM
|
Facility
|
IP
|
$2,556.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$2,172.60 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,789.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,022.40
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,623.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,508.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.44
|
| Rate for Payer: Multiplan Commercial |
$2,044.80
|
| Rate for Payer: Networks By Design Commercial |
$1,661.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
OP
|
$2,556.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| 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 |
$1,150.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cigna of CA HMO |
$1,635.84
|
| Rate for Payer: Cigna of CA PPO |
$1,891.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,789.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| 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 |
$1,623.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$644.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.44
|
| 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 |
$2,044.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,661.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,533.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,278.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,278.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,278.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,278.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 5.1-7.5 CM
|
Facility
|
IP
|
$2,556.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$2,172.60 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,789.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,022.40
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,623.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,508.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.44
|
| Rate for Payer: Multiplan Commercial |
$2,044.80
|
| Rate for Payer: Networks By Design Commercial |
$1,661.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
OP
|
$2,556.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,047.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,357.56
|
| 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 |
$1,150.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cigna of CA HMO |
$1,635.84
|
| Rate for Payer: Cigna of CA PPO |
$1,891.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,789.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| 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 |
$1,623.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$644.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.44
|
| 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 |
$2,044.80
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,661.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,533.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,533.60
|
| 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 WNDS GT 30.0 CM
|
Facility
|
IP
|
$3,358.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$671.60 |
| Max. Negotiated Rate |
$2,854.30 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,350.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,343.20
|
| Rate for Payer: Galaxy Health WC |
$2,854.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,132.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,981.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.92
|
| Rate for Payer: Multiplan Commercial |
$2,686.40
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
|
|
HC LAY CLOS OF WNDS GT 30.0 CM
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.85 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| 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 |
$1,511.10
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Cigna of CA HMO |
$2,149.12
|
| Rate for Payer: Cigna of CA PPO |
$2,484.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$2,350.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,854.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| 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 |
$2,132.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,065.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.92
|
| 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 |
$2,686.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,014.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,679.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,679.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,679.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,679.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 LT 2.5,NCK,HA
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| 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 |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna of CA HMO |
$926.72
|
| Rate for Payer: Cigna of CA PPO |
$1,071.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,013.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| 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 |
$919.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| 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 |
$1,158.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$724.00
|
| Rate for Payer: United Healthcare All Other HMO |
$724.00
|
| Rate for Payer: United Healthcare HMO Rider |
$724.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 LT 2.5,NCK,HA
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$1,230.80 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,013.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.20
|
| Rate for Payer: EPIC Health Plan Senior |
$579.20
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$919.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$854.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| Rate for Payer: Multiplan Commercial |
$1,158.40
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$178.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$593.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,081.14
|
| 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 |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna of CA HMO |
$926.72
|
| Rate for Payer: Cigna of CA PPO |
$1,071.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,013.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| 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 |
$919.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| 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 |
$1,158.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$868.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$868.80
|
| 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 |
$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 LT 2.5,NCK,HA
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$1,230.80 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,013.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.20
|
| Rate for Payer: EPIC Health Plan Senior |
$579.20
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$919.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$854.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| Rate for Payer: Multiplan Commercial |
$1,158.40
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
|
|
HC L&D EA ADD'L 15 MIN
|
Facility
|
OP
|
$952.00
|
|
| Hospital Charge Code |
902400057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$809.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$714.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$610.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$809.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$809.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$561.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$666.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$666.40
|
| Rate for Payer: Multiplan Commercial |
$761.60
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other HMO |
$476.00
|
| Rate for Payer: United Healthcare HMO Rider |
$476.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$809.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.20
|
| Rate for Payer: Vantage Medical Group Senior |
$809.20
|
|
|
HC L&D EA ADD'L 15 MIN
|
Facility
|
IP
|
$952.00
|
|
| Hospital Charge Code |
902400057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$809.20 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$561.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.48
|
| Rate for Payer: Multiplan Commercial |
$761.60
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
IP
|
$4,505.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.00 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: Adventist Health Commercial |
$901.00
|
| Rate for Payer: Cash Price |
$2,027.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,802.00
|
| Rate for Payer: Galaxy Health WC |
$3,829.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,703.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,860.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,657.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,081.20
|
| Rate for Payer: Multiplan Commercial |
$3,604.00
|
| Rate for Payer: Networks By Design Commercial |
$2,928.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,829.25
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
OP
|
$4,505.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$901.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,829.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,477.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,890.86
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,027.25
|
| Rate for Payer: Cash Price |
$2,027.25
|
| Rate for Payer: Cigna of CA HMO |
$2,883.20
|
| Rate for Payer: Cigna of CA PPO |
$3,333.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,829.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,829.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,829.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,802.00
|
| Rate for Payer: Galaxy Health WC |
$3,829.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,703.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,860.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,635.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,657.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,081.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,153.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,153.50
|
| Rate for Payer: Multiplan Commercial |
$3,604.00
|
| Rate for Payer: Networks By Design Commercial |
$2,928.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,829.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,703.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,252.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,252.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,252.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,252.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,829.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,829.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,829.25
|
|
|
HC L&D LEVEL II - 1ST HR
|
Facility
|
OP
|
$5,516.00
|
|
| Hospital Charge Code |
902400052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,103.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,103.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,688.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,033.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,539.62
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,482.20
|
| Rate for Payer: Cash Price |
$2,482.20
|
| Rate for Payer: Cigna of CA HMO |
$3,530.24
|
| Rate for Payer: Cigna of CA PPO |
$4,081.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,688.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,688.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,688.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,861.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,206.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,206.40
|
| Rate for Payer: Galaxy Health WC |
$4,688.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,309.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,502.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,002.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,254.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,861.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,861.20
|
| Rate for Payer: Multiplan Commercial |
$4,412.80
|
| Rate for Payer: Networks By Design Commercial |
$3,585.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,688.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,309.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,758.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,758.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,688.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,688.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,688.60
|
|
