|
HC LASER TREATMENT
|
Facility
IP
|
$9,636.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,927.20 |
| Max. Negotiated Rate |
$8,672.40 |
| Rate for Payer: Cash Price |
$4,336.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,854.40
|
| Rate for Payer: Galaxy Health WC |
$8,190.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,672.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,427.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.20
|
| Rate for Payer: Multiplan Commercial |
$7,227.00
|
| Rate for Payer: Networks By Design Commercial |
$6,263.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,190.60
|
|
|
HC LASER TREATMENT
|
Facility
OP
|
$9,636.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$8,672.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,678.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,781.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,678.93
|
| Rate for Payer: Cash Price |
$4,336.20
|
| Rate for Payer: Cash Price |
$4,336.20
|
| Rate for Payer: Cash Price |
$4,336.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.80
|
| Rate for Payer: Cigna of CA HMO |
$6,167.04
|
| Rate for Payer: Cigna of CA PPO |
$7,130.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$8,190.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,672.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,227.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,673.45
|
| Rate for Payer: IEHP medi-cal |
$7,720.23
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Innovage PACE Commercial |
$7,018.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,427.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,269.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$7,227.00
|
| Rate for Payer: Networks By Design Commercial |
$6,263.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,190.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,959.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,781.60
|
| Rate for Payer: Riverside University Health MISP |
$5,146.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,781.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,781.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC LASIX RENOGRAM
|
Facility
OP
|
$4,312.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$675.33 |
| Max. Negotiated Rate |
$3,880.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,668.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$930.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,547.53
|
| Rate for Payer: BCBS Transplant Transplant |
$2,587.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,664.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,095.63
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$1,940.40
|
| Rate for Payer: Cash Price |
$1,940.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,449.60
|
| Rate for Payer: Cigna of CA HMO |
$2,759.68
|
| Rate for Payer: Cigna of CA PPO |
$3,190.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$3,665.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,587.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,880.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,234.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: IEHP medi-cal |
$1,114.29
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Innovage PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,876.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$3,234.00
|
| Rate for Payer: Networks By Design Commercial |
$2,802.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,665.20
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,587.20
|
| Rate for Payer: Riverside University Health MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,587.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,587.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC LASIX RENOGRAM
|
Facility
IP
|
$4,312.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$862.40 |
| Max. Negotiated Rate |
$3,880.80 |
| Rate for Payer: Cash Price |
$1,940.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,449.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,724.80
|
| Rate for Payer: Galaxy Health WC |
$3,665.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,587.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,880.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,876.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.40
|
| Rate for Payer: Multiplan Commercial |
$3,234.00
|
| Rate for Payer: Networks By Design Commercial |
$2,802.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,665.20
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
OP
|
$12,570.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,313.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,542.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,056.00
|
| Rate for Payer: Cigna of CA PPO |
$9,301.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$10,684.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,542.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,313.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,427.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,514.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$9,427.50
|
| Rate for Payer: Networks By Design Commercial |
$8,170.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,684.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,542.00
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,542.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,285.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,285.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
IP
|
$12,570.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,514.00 |
| Max. Negotiated Rate |
$11,313.00 |
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,056.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,028.00
|
| Rate for Payer: Galaxy Health WC |
$10,684.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,542.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,313.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,384.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,514.00
|
| Rate for Payer: Multiplan Commercial |
$9,427.50
|
| Rate for Payer: Networks By Design Commercial |
$8,170.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,684.50
|
|
|
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 |
$141.75 |
| Max. Negotiated Rate |
$649.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$649.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$222.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.27
|
| Rate for Payer: BCBS Transplant Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$303.75
|
| Rate for Payer: Blue Shield of California EPN |
$220.32
|
| 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: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$303.75
|
| Rate for Payer: IEHP medi-cal |
$141.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| 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 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 |
$202.50
|
| Rate for Payer: United Healthcare All Other HMO |
$202.50
|
| Rate for Payer: United Healthcare HMO Rider |
$202.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.50
|
| 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 |
905352680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Blue Shield of California EPN |
$216.27
|
| 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 Transplant |
$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 |
$270.14
|
| 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 |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
OP
|
$2,903.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$498.20 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,741.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,825.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,419.57
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,322.40
|
| Rate for Payer: Cigna of CA HMO |
$1,857.92
|
| Rate for Payer: Cigna of CA PPO |
$2,148.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,467.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,741.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,612.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,177.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$2,177.25
|
| Rate for Payer: Networks By Design Commercial |
$1,886.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,467.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,741.80
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,741.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,741.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,451.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,451.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,451.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,451.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
IP
|
$2,903.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$580.60 |
| Max. Negotiated Rate |
$2,612.70 |
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,322.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,161.20
|
| Rate for Payer: Galaxy Health WC |
$2,467.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,741.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,612.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,936.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.60
|
| Rate for Payer: Multiplan Commercial |
$2,177.25
|
| Rate for Payer: Networks By Design Commercial |
$1,886.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,467.55
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
OP
|
$2,903.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,741.80
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,322.40
|
| Rate for Payer: Cigna of CA PPO |
$2,148.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,467.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,741.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,612.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,177.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$2,177.25
|
| Rate for Payer: Networks By Design Commercial |
$1,886.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,467.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,741.80
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,741.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,451.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,451.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,451.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,451.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
IP
|
$2,903.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$580.60 |
| Max. Negotiated Rate |
$2,612.70 |
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,322.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,161.20
|
| Rate for Payer: Galaxy Health WC |
$2,467.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,741.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,612.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,936.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.60
|
| Rate for Payer: Multiplan Commercial |
$2,177.25
|
| Rate for Payer: Networks By Design Commercial |
$1,886.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,467.55
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$638.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,915.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,007.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,560.89
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,553.60
|
| Rate for Payer: Cigna of CA HMO |
$2,042.88
|
| Rate for Payer: Cigna of CA PPO |
$2,362.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,713.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,872.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,394.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$1,294.77
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$2,394.00
|
| Rate for Payer: Networks By Design Commercial |
$2,074.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,713.20
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,915.20
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,596.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,596.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,596.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
IP
|
$3,192.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$638.40 |
| Max. Negotiated Rate |
$2,872.80 |
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,553.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,276.80
|
| Rate for Payer: Galaxy Health WC |
$2,713.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,872.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.40
|
| Rate for Payer: Multiplan Commercial |
$2,394.00
|
| Rate for Payer: Networks By Design Commercial |
$2,074.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,713.20
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,915.20
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,553.60
|
| Rate for Payer: Cigna of CA PPO |
$2,362.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,713.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,872.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,394.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$2,394.00
|
| Rate for Payer: Networks By Design Commercial |
$2,074.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,713.20
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,915.20
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,596.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,596.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,596.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
IP
|
$3,192.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$638.40 |
| Max. Negotiated Rate |
$2,872.80 |
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,553.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,276.80
|
| Rate for Payer: Galaxy Health WC |
$2,713.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,872.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.40
|
| Rate for Payer: Multiplan Commercial |
$2,394.00
|
| Rate for Payer: Networks By Design Commercial |
$2,074.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,713.20
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
IP
|
$1,746.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$1,571.40 |
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.40
|
| Rate for Payer: Galaxy Health WC |
$1,484.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,571.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,164.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,309.50
|
| Rate for Payer: Networks By Design Commercial |
$1,134.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.10
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
IP
|
$1,746.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$1,571.40 |
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.40
|
| Rate for Payer: Galaxy Health WC |
$1,484.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,571.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,164.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,309.50
|
| Rate for Payer: Networks By Design Commercial |
$1,134.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.10
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
OP
|
$1,746.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,047.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.23
|
| Rate for Payer: Blue Shield of California EPN |
$853.79
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.80
|
| Rate for Payer: Cigna of CA HMO |
$1,117.44
|
| Rate for Payer: Cigna of CA PPO |
$1,292.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,484.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,571.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,309.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,309.50
|
| Rate for Payer: Networks By Design Commercial |
$1,134.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.10
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,047.60
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,047.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$873.00
|
| Rate for Payer: United Healthcare All Other HMO |
$873.00
|
| Rate for Payer: United Healthcare HMO Rider |
$873.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$873.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
OP
|
$1,746.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,047.60
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.80
|
| Rate for Payer: Cigna of CA PPO |
$1,292.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,484.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,571.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,309.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,309.50
|
| Rate for Payer: Networks By Design Commercial |
$1,134.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.10
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,047.60
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$873.00
|
| Rate for Payer: United Healthcare All Other HMO |
$873.00
|
| Rate for Payer: United Healthcare HMO Rider |
$873.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$873.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
OP
|
$2,455.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$491.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,473.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,544.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,200.50
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,964.00
|
| Rate for Payer: Cigna of CA HMO |
$1,571.20
|
| Rate for Payer: Cigna of CA PPO |
$1,816.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,086.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,209.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,841.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,637.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,841.25
|
| Rate for Payer: Networks By Design Commercial |
$1,595.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,086.75
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,473.00
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,473.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,227.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,227.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,227.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,227.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
OP
|
$2,455.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,473.00
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,964.00
|
| Rate for Payer: Cigna of CA PPO |
$1,816.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,086.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,209.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,841.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,637.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,841.25
|
| Rate for Payer: Networks By Design Commercial |
$1,595.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,086.75
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,473.00
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,227.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,227.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,227.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,227.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
IP
|
$2,455.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.00 |
| Max. Negotiated Rate |
$2,209.50 |
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,964.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.00
|
| Rate for Payer: Galaxy Health WC |
$2,086.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,209.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,637.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Multiplan Commercial |
$1,841.25
|
| Rate for Payer: Networks By Design Commercial |
$1,595.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,086.75
|
|
|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
IP
|
$2,455.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$491.00 |
| Max. Negotiated Rate |
$2,209.50 |
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,964.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.00
|
| Rate for Payer: Galaxy Health WC |
$2,086.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,209.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,637.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Multiplan Commercial |
$1,841.25
|
| Rate for Payer: Networks By Design Commercial |
$1,595.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,086.75
|
|
|
HC LAY CLOS OF WND GT 30.0 CM
|
Facility
IP
|
$3,587.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
900501643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$717.40 |
| Max. Negotiated Rate |
$3,228.30 |
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,869.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,434.80
|
| Rate for Payer: Galaxy Health WC |
$3,048.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,152.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,228.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,392.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.40
|
| Rate for Payer: Multiplan Commercial |
$2,690.25
|
| Rate for Payer: Networks By Design Commercial |
$2,331.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,048.95
|
|
