|
HC LASIX RENOGRAM
|
Facility
|
IP
|
$3,482.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$696.40 |
| Max. Negotiated Rate |
$3,133.80 |
| Rate for Payer: Adventist Health Commercial |
$696.40
|
| Rate for Payer: Cash Price |
$1,566.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,785.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,437.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,392.80
|
| Rate for Payer: Galaxy Health WC |
$2,959.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,089.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,133.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,211.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,054.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.40
|
| Rate for Payer: Multiplan Commercial |
$2,611.50
|
| Rate for Payer: Networks By Design Commercial |
$2,263.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,959.70
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
OP
|
$16,624.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.25 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,324.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,557.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$7,480.80
|
| Rate for Payer: Cash Price |
$7,480.80
|
| Rate for Payer: Cash Price |
$7,480.80
|
| Rate for Payer: Central Health Plan Commercial |
$13,299.20
|
| Rate for Payer: Cigna of CA HMO |
$10,639.36
|
| Rate for Payer: Cigna of CA PPO |
$12,301.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,636.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,013.60
|
| Rate for Payer: Galaxy Health WC |
$14,130.40
|
| Rate for Payer: Global Benefits Group Commercial |
$9,974.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,961.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,474.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$943.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,556.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,041.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,380.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,324.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,107.48
|
| Rate for Payer: Multiplan Commercial |
$12,468.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$10,805.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$14,130.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,831.29
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$5,013.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,974.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,312.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,557.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
IP
|
$16,624.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,324.80 |
| Max. Negotiated Rate |
$14,961.60 |
| Rate for Payer: Adventist Health Commercial |
$3,324.80
|
| Rate for Payer: Cash Price |
$7,480.80
|
| Rate for Payer: Central Health Plan Commercial |
$13,299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,636.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,649.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,649.60
|
| Rate for Payer: Galaxy Health WC |
$14,130.40
|
| Rate for Payer: Global Benefits Group Commercial |
$9,974.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,961.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,556.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,808.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,324.80
|
| Rate for Payer: Multiplan Commercial |
$12,468.00
|
| Rate for Payer: Networks By Design Commercial |
$10,805.60
|
| Rate for Payer: Prime Health Services Commercial |
$14,130.40
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
IP
|
$16,624.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,324.80 |
| Max. Negotiated Rate |
$14,961.60 |
| Rate for Payer: Adventist Health Commercial |
$3,324.80
|
| Rate for Payer: Cash Price |
$7,480.80
|
| Rate for Payer: Central Health Plan Commercial |
$13,299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,636.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,649.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,649.60
|
| Rate for Payer: Galaxy Health WC |
$14,130.40
|
| Rate for Payer: Global Benefits Group Commercial |
$9,974.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,961.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,556.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,808.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,324.80
|
| Rate for Payer: Multiplan Commercial |
$12,468.00
|
| Rate for Payer: Networks By Design Commercial |
$10,805.60
|
| Rate for Payer: Prime Health Services Commercial |
$14,130.40
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
OP
|
$16,624.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,961.60 |
| Rate for Payer: Adventist Health Commercial |
$3,324.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$7,480.80
|
| Rate for Payer: Cash Price |
$7,480.80
|
| Rate for Payer: Cash Price |
$7,480.80
|
| Rate for Payer: Cash Price |
$7,480.80
|
| Rate for Payer: Central Health Plan Commercial |
$13,299.20
|
| Rate for Payer: Cigna of CA HMO |
$10,639.36
|
| Rate for Payer: Cigna of CA PPO |
$12,301.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,636.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,013.60
|
| Rate for Payer: Galaxy Health WC |
$14,130.40
|
| Rate for Payer: Global Benefits Group Commercial |
$9,974.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,961.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,474.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,556.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,041.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,899.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,324.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,107.48
|
| Rate for Payer: Multiplan Commercial |
$12,468.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$10,805.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$14,130.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,831.29
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$5,013.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,974.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,312.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,312.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,557.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
|
|
HC LAT SUPPORT UPRIGHTS ADD LE
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L2680
|
| Hospital Charge Code |
905352680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$324.81
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC LAT SUPPORT UPRIGHTS ADD LE
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L2680
|
| Hospital Charge Code |
915352680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.59
|
| Rate for Payer: Blue Shield of California Commercial |
$324.81
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Riverside University Health System MISP |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC LAT SUPPORT UPRIGHTS ADD LE
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L2680
|
| Hospital Charge Code |
915352680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$324.81
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC LAT SUPPORT UPRIGHTS ADD LE
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L2680
|
| Hospital Charge Code |
905352680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.59
|
| Rate for Payer: Blue Shield of California Commercial |
$324.81
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Riverside University Health System MISP |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
IP
|
$3,839.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$767.80 |
| Max. Negotiated Rate |
$3,455.10 |
| Rate for Payer: Adventist Health Commercial |
$767.80
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,071.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,687.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,535.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,535.60
|
| Rate for Payer: Galaxy Health WC |
$3,263.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,303.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,455.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,437.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,265.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.80
|
| Rate for Payer: Multiplan Commercial |
$2,879.25
|
| Rate for Payer: Networks By Design Commercial |
$2,495.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,263.15
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
OP
|
$3,839.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.04 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$767.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,071.20
|
| Rate for Payer: Cigna of CA HMO |
$2,456.96
|
| Rate for Payer: Cigna of CA PPO |
$2,840.86
|
| 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 |
$2,687.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$3,263.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,303.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,455.10
|
| 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 |
$2,437.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$2,879.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,495.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,263.15
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,303.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,919.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,919.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,919.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,919.50
|
| 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 12.6-20.0 CM
|
Facility
|
OP
|
$3,839.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$215.04 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,573.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,296.96
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,071.20
|
| Rate for Payer: Cigna of CA HMO |
$2,456.96
|
| Rate for Payer: Cigna of CA PPO |
$2,840.86
|
| 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 |
$2,687.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$3,263.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,303.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,455.10
|
| 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 |
$2,437.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$2,879.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,495.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,263.15
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,303.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,303.40
|
| 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 WND 12.6-20.0 CM
|
Facility
|
IP
|
$3,839.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$767.80 |
| Max. Negotiated Rate |
$3,455.10 |
| Rate for Payer: Adventist Health Commercial |
$767.80
|
| Rate for Payer: Cash Price |
$1,727.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,071.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,687.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,535.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,535.60
|
| Rate for Payer: Galaxy Health WC |
$3,263.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,303.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,455.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,437.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,265.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.80
|
| Rate for Payer: Multiplan Commercial |
$2,879.25
|
| Rate for Payer: Networks By Design Commercial |
$2,495.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,263.15
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
IP
|
$4,222.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$844.40 |
| Max. Negotiated Rate |
$3,799.80 |
| Rate for Payer: Adventist Health Commercial |
$844.40
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,377.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,955.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,688.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,688.80
|
| Rate for Payer: Galaxy Health WC |
$3,588.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,533.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,799.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,680.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,490.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.40
|
| Rate for Payer: Multiplan Commercial |
$3,166.50
|
| Rate for Payer: Networks By Design Commercial |
$2,744.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,588.70
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
IP
|
$4,222.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$844.40 |
| Max. Negotiated Rate |
$3,799.80 |
| Rate for Payer: Adventist Health Commercial |
$844.40
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,377.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,955.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,688.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,688.80
|
| Rate for Payer: Galaxy Health WC |
$3,588.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,533.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,799.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,680.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,490.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.40
|
| Rate for Payer: Multiplan Commercial |
$3,166.50
|
| Rate for Payer: Networks By Design Commercial |
$2,744.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,588.70
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
OP
|
$4,222.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,731.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,476.56
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,377.60
|
| Rate for Payer: Cigna of CA HMO |
$2,702.08
|
| Rate for Payer: Cigna of CA PPO |
$3,124.28
|
| 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 |
$2,955.40
|
| 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 |
$3,588.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,533.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,799.80
|
| 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 |
$2,680.97
|
| 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 |
$844.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$3,166.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$2,744.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$3,588.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,533.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,533.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
OP
|
$4,222.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$844.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,377.60
|
| Rate for Payer: Cigna of CA HMO |
$2,702.08
|
| Rate for Payer: Cigna of CA PPO |
$3,124.28
|
| 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 |
$2,955.40
|
| 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 |
$3,588.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,533.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,799.80
|
| 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 |
$2,680.97
|
| 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 |
$844.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$3,166.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$2,744.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$3,588.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,533.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,111.00
|
| 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
|
OP
|
$2,309.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$946.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,097.92
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,847.20
|
| Rate for Payer: Cigna of CA HMO |
$1,477.76
|
| Rate for Payer: Cigna of CA PPO |
$1,708.66
|
| 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 |
$1,616.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,962.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,385.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,078.10
|
| 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 |
$1,466.21
|
| 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 |
$461.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,731.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,500.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,962.65
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,385.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,385.40
|
| 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 WND 2.6-7.5CM
|
Facility
|
OP
|
$2,309.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$461.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,847.20
|
| Rate for Payer: Cigna of CA HMO |
$1,477.76
|
| Rate for Payer: Cigna of CA PPO |
$1,708.66
|
| 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 |
$1,616.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,962.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,385.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,078.10
|
| 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 |
$1,466.21
|
| 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 |
$461.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,731.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,500.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,962.65
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,385.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,154.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,154.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,154.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,154.50
|
| 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 2.6-7.5CM
|
Facility
|
IP
|
$2,309.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$461.80 |
| Max. Negotiated Rate |
$2,078.10 |
| Rate for Payer: Adventist Health Commercial |
$461.80
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,847.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,616.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.60
|
| Rate for Payer: EPIC Health Plan Senior |
$923.60
|
| Rate for Payer: Galaxy Health WC |
$1,962.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,385.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,078.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,466.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,362.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.80
|
| Rate for Payer: Multiplan Commercial |
$1,731.75
|
| Rate for Payer: Networks By Design Commercial |
$1,500.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,962.65
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
IP
|
$2,309.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$461.80 |
| Max. Negotiated Rate |
$2,078.10 |
| Rate for Payer: Adventist Health Commercial |
$461.80
|
| Rate for Payer: Cash Price |
$1,039.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,847.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,616.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.60
|
| Rate for Payer: EPIC Health Plan Senior |
$923.60
|
| Rate for Payer: Galaxy Health WC |
$1,962.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,385.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,078.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,466.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,362.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.80
|
| Rate for Payer: Multiplan Commercial |
$1,731.75
|
| Rate for Payer: Networks By Design Commercial |
$1,500.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,962.65
|
|
|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
|
IP
|
$3,246.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$649.20 |
| Max. Negotiated Rate |
$2,921.40 |
| Rate for Payer: Adventist Health Commercial |
$649.20
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,596.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,272.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,298.40
|
| Rate for Payer: Galaxy Health WC |
$2,759.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,947.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,921.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,061.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,915.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.20
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
| Rate for Payer: Networks By Design Commercial |
$2,109.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,759.10
|
|
|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
|
OP
|
$3,246.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,330.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,126.27
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,596.80
|
| Rate for Payer: Cigna of CA HMO |
$2,077.44
|
| Rate for Payer: Cigna of CA PPO |
$2,402.04
|
| 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 |
$2,272.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,759.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,947.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,921.40
|
| 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 |
$2,061.21
|
| 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 |
$649.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,109.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,759.10
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,947.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,947.60
|
| 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 7.6-12.5 CM
|
Facility
|
OP
|
$3,246.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$649.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,596.80
|
| Rate for Payer: Cigna of CA HMO |
$2,077.44
|
| Rate for Payer: Cigna of CA PPO |
$2,402.04
|
| 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 |
$2,272.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,759.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,947.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,921.40
|
| 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 |
$2,061.21
|
| 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 |
$649.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,109.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,759.10
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,947.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,623.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,623.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,623.00
|
| 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
|
$3,246.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$649.20 |
| Max. Negotiated Rate |
$2,921.40 |
| Rate for Payer: Adventist Health Commercial |
$649.20
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,596.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,272.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,298.40
|
| Rate for Payer: Galaxy Health WC |
$2,759.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,947.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,921.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,061.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,915.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.20
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
| Rate for Payer: Networks By Design Commercial |
$2,109.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,759.10
|
|
