|
HC LASER TREATMENT
|
Facility
|
IP
|
$11,348.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,269.60 |
| Max. Negotiated Rate |
$10,213.20 |
| Rate for Payer: Adventist Health Commercial |
$2,269.60
|
| Rate for Payer: Cash Price |
$5,106.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,078.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,539.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,539.20
|
| Rate for Payer: Galaxy Health WC |
$9,645.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,808.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,213.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,569.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,323.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,024.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,269.60
|
| Rate for Payer: Multiplan Commercial |
$8,511.00
|
| Rate for Payer: Networks By Design Commercial |
$7,376.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,645.80
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,322.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,326.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,155.36
|
| 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 LASIX RENOGRAM
|
Facility
|
OP
|
$3,482.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$314.12 |
| Max. Negotiated Rate |
$3,133.80 |
| Rate for Payer: Adventist Health Commercial |
$696.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,114.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$930.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,044.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,113.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.35
|
| Rate for Payer: Cash Price |
$1,566.90
|
| Rate for Payer: Cash Price |
$1,566.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,785.60
|
| Rate for Payer: Cigna of CA HMO |
$2,228.48
|
| Rate for Payer: Cigna of CA PPO |
$2,576.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| 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: Heritage Provider Network Commercial/Senior |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,322.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$2,611.50
|
| Rate for Payer: Networks By Design Commercial |
$2,263.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$2,959.70
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,089.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,089.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| 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 |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$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 |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,088.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,041.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,324.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| 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 |
$2,324.22
|
| 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 |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| 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 |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$11,088.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,333.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,290.26
|
| 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
|
361
|
| Min. Negotiated Rate |
$943.25 |
| Max. Negotiated Rate |
$14,961.60 |
| Rate for Payer: Adventist Health Commercial |
$3,324.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,324.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| 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 |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$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 |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$943.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,088.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,041.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,324.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| 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 |
$2,324.22
|
| 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 |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,974.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| 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 |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$11,088.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,333.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,290.26
|
| 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 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 |
$237.86
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| 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: 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: InnovAge PACE Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$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 |
$313.06
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| 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
|
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 |
$313.06
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| 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 |
$237.86
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| 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: 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: InnovAge PACE Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$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
|
OP
|
$3,839.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$215.04 |
| Max. Negotiated Rate |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| 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 |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$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 |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,560.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| 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 |
$507.64
|
| 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 |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND 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 |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| 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 |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$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 |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,560.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| 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 |
$507.64
|
| 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 |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND 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: 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 Permanente of CA Commercial/Self Funded |
$2,560.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,462.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,376.34
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,560.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,462.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,376.34
|
| 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
|
OP
|
$4,222.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| 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 |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,816.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$752.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| 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 |
$777.77
|
| 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 |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| 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 |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC LAY CLOS OF 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: 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 Permanente of CA Commercial/Self Funded |
$2,816.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,608.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,613.42
|
| 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
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| 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 |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,816.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$752.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| 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 |
$777.77
|
| 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 |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| 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 |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC LAY CLOS OF 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: 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 Permanente of CA Commercial/Self Funded |
$2,816.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,608.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,613.42
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$879.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,429.27
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$879.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,429.27
|
| 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
|
OP
|
$2,309.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,962.65
|
| 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 |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| 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 |
$507.64
|
| 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 |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND 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 |
$5,311.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| 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 |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,962.65
|
| 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 |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| 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 |
$507.64
|
| 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 |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND 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 |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| 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 |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,759.10
|
| 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 |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,165.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| 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 |
$507.64
|
| 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 |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND 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: 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 Permanente of CA Commercial/Self Funded |
$2,165.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,009.27
|
| 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
|
|
