|
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: Kaiser Permanente of CA Medi-Cal |
$1,366.65
|
| 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
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.00 |
| Max. Negotiated Rate |
$1,966.50 |
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Galaxy Health WC |
$1,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,311.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,966.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,457.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$832.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.00
|
| Rate for Payer: Multiplan Commercial |
$1,638.75
|
| Rate for Payer: Networks By Design Commercial |
$1,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,857.25
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$437.00 |
| Max. Negotiated Rate |
$1,966.50 |
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Galaxy Health WC |
$1,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,311.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,966.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,457.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$832.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.00
|
| Rate for Payer: Multiplan Commercial |
$1,638.75
|
| Rate for Payer: Networks By Design Commercial |
$1,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,857.25
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$437.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,374.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,068.46
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,748.00
|
| Rate for Payer: Cigna of CA HMO |
$1,398.40
|
| Rate for Payer: Cigna of CA PPO |
$1,616.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$1,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,311.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,966.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,638.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,457.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.00
|
| 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 |
$1,638.75
|
| Rate for Payer: Networks By Design Commercial |
$1,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,857.25
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,311.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,311.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,092.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,092.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,092.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,092.50
|
| 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 LT 2.5 CM FACE
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$437.00 |
| Max. Negotiated Rate |
$1,966.50 |
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Galaxy Health WC |
$1,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,311.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,966.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,457.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$832.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.00
|
| Rate for Payer: Multiplan Commercial |
$1,638.75
|
| Rate for Payer: Networks By Design Commercial |
$1,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,857.25
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,311.00
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,748.00
|
| Rate for Payer: Cigna of CA PPO |
$1,616.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$1,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,311.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,966.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,638.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,457.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.00
|
| 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 |
$1,638.75
|
| Rate for Payer: Networks By Design Commercial |
$1,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,857.25
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,311.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,092.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,092.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,092.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,092.50
|
| 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 LT 2.5 CM FACE
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.00 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,748.00
|
| Rate for Payer: Cigna of CA PPO |
$1,616.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$1,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,311.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,966.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,638.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,457.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.00
|
| 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 |
$1,638.75
|
| Rate for Payer: Networks By Design Commercial |
$1,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,857.25
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,311.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| 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 LT 2.5 CM SCALP
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.80 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$875.40
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: Cigna of CA PPO |
$1,079.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,094.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| 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 |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$875.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$729.50
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$729.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.50
|
| 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 LT 2.5 CM SCALP
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$291.80 |
| Max. Negotiated Rate |
$1,313.10 |
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$583.60
|
| Rate for Payer: Galaxy Health WC |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| Rate for Payer: Multiplan Commercial |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
|
|
HC LAY CLOS OF WND LT 2.5 CM SCALP
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.80 |
| Max. Negotiated Rate |
$1,313.10 |
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$583.60
|
| Rate for Payer: Galaxy Health WC |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| Rate for Payer: Multiplan Commercial |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
|
|
HC LAY CLOS OF WND LT 2.5 CM SCALP
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$291.80 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$875.40
|
| Rate for Payer: Blue Shield of California Commercial |
$917.71
|
| Rate for Payer: Blue Shield of California EPN |
$713.45
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: Cigna of CA HMO |
$933.76
|
| Rate for Payer: Cigna of CA PPO |
$1,079.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,094.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| 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 |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$875.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$875.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$729.50
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$729.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.50
|
| 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 WNDS 12.6- 20.0 CM
|
Facility
|
OP
|
$2,358.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
900501416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.43 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$1,414.80
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,886.40
|
| Rate for Payer: Cigna of CA PPO |
$1,744.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| 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 |
$2,004.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,414.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,122.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,768.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,572.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.60
|
| 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 |
$1,768.50
|
| Rate for Payer: Networks By Design Commercial |
$1,532.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,004.30
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,179.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,179.00
|
| 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 WNDS 12.6- 20.0 CM
|
Facility
|
IP
|
$2,358.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
900501416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$471.60 |
| Max. Negotiated Rate |
$2,122.20 |
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,886.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$943.20
|
| Rate for Payer: Galaxy Health WC |
$2,004.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,414.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,122.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,572.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$898.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.60
|
| Rate for Payer: Multiplan Commercial |
$1,768.50
|
| Rate for Payer: Networks By Design Commercial |
$1,532.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,004.30
|
|
|
HC LAY CLOS OF WNDS 12.6-20.0 CM
|
Facility
|
IP
|
$2,884.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.80 |
| Max. Negotiated Rate |
$2,595.60 |
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,307.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,153.60
|
| Rate for Payer: Galaxy Health WC |
$2,451.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,730.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,595.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,923.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.80
|
| Rate for Payer: Multiplan Commercial |
$2,163.00
|
| Rate for Payer: Networks By Design Commercial |
$1,874.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,451.40
|
|
|
HC LAY CLOS OF WNDS 12.6-20.0 CM
|
Facility
|
OP
|
$2,884.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$1,730.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,814.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,410.28
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,307.20
|
| Rate for Payer: Cigna of CA HMO |
$1,845.76
|
| Rate for Payer: Cigna of CA PPO |
$2,134.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$2,451.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,730.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,595.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,163.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,923.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.80
|
| 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 |
$2,163.00
|
| Rate for Payer: Networks By Design Commercial |
$1,874.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,451.40
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,730.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,730.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,442.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,442.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,442.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,442.00
|
| 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 WNDS 12.6-20.0 CM
|
Facility
|
IP
|
$2,884.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$576.80 |
| Max. Negotiated Rate |
$2,595.60 |
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,307.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,153.60
|
| Rate for Payer: Galaxy Health WC |
$2,451.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,730.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,595.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,923.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.80
|
| Rate for Payer: Multiplan Commercial |
$2,163.00
|
| Rate for Payer: Networks By Design Commercial |
$1,874.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,451.40
|
|
|
HC LAY CLOS OF WNDS 12.6-20.0 CM
|
Facility
|
OP
|
$2,884.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$1,730.40
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,307.20
|
| Rate for Payer: Cigna of CA PPO |
$2,134.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$2,451.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,730.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,595.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,163.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,923.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.80
|
| 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 |
$2,163.00
|
| Rate for Payer: Networks By Design Commercial |
$1,874.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,451.40
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,730.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,442.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,442.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,442.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,442.00
|
| 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 WNDS 20.1-30.0 CM
|
Facility
|
IP
|
$3,028.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
900501525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$605.60 |
| Max. Negotiated Rate |
$2,725.20 |
| Rate for Payer: Cash Price |
$1,362.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,422.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,211.20
|
| Rate for Payer: Galaxy Health WC |
$2,573.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,816.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,725.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,019.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,153.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.60
|
| Rate for Payer: Multiplan Commercial |
$2,271.00
|
| Rate for Payer: Networks By Design Commercial |
$1,968.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,573.80
|
|
|
HC LAY CLOS OF WNDS 20.1-30.0 CM
|
Facility
|
OP
|
$3,028.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
900501525
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$1,816.80
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,362.60
|
| Rate for Payer: Cash Price |
$1,362.60
|
| Rate for Payer: Cash Price |
$1,362.60
|
| Rate for Payer: Cash Price |
$1,362.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,422.40
|
| Rate for Payer: Cigna of CA PPO |
$2,240.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$2,573.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,816.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,725.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,271.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,019.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.60
|
| 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 |
$2,271.00
|
| Rate for Payer: Networks By Design Commercial |
$1,968.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,573.80
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,514.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,514.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,514.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,514.00
|
| 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 WNDS 2.6-5.0 CM
|
Facility
|
IP
|
$2,490.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$498.00 |
| Max. Negotiated Rate |
$2,241.00 |
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$996.00
|
| Rate for Payer: Galaxy Health WC |
$2,116.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,494.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,241.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,660.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.00
|
| Rate for Payer: Multiplan Commercial |
$1,867.50
|
| Rate for Payer: Networks By Design Commercial |
$1,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,116.50
|
|
|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
OP
|
$2,490.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,494.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,566.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,217.61
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,992.00
|
| Rate for Payer: Cigna of CA HMO |
$1,593.60
|
| Rate for Payer: Cigna of CA PPO |
$1,842.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$2,116.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,494.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,241.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,867.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,660.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.00
|
| 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 |
$1,867.50
|
| Rate for Payer: Networks By Design Commercial |
$1,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,116.50
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,494.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,494.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,245.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,245.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,245.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,245.00
|
| 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 WNDS 2.6-5.0 CM
|
Facility
|
OP
|
$2,490.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,494.00
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,992.00
|
| Rate for Payer: Cigna of CA PPO |
$1,842.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$2,116.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,494.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,241.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,867.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,660.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.00
|
| 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 |
$1,867.50
|
| Rate for Payer: Networks By Design Commercial |
$1,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,116.50
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,494.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,245.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,245.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,245.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,245.00
|
| 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 WNDS 2.6-5.0 CM
|
Facility
|
IP
|
$2,490.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$498.00 |
| Max. Negotiated Rate |
$2,241.00 |
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$996.00
|
| Rate for Payer: Galaxy Health WC |
$2,116.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,494.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,241.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,660.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.00
|
| Rate for Payer: Multiplan Commercial |
$1,867.50
|
| Rate for Payer: Networks By Design Commercial |
$1,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,116.50
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
OP
|
$1,724.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$189.58 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,034.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,084.40
|
| Rate for Payer: Blue Shield of California EPN |
$843.04
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,379.20
|
| Rate for Payer: Cigna of CA HMO |
$1,103.36
|
| Rate for Payer: Cigna of CA PPO |
$1,275.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| 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 |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,551.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,293.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.80
|
| 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 |
$1,293.00
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,034.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,034.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$862.00
|
| Rate for Payer: United Healthcare All Other HMO |
$862.00
|
| Rate for Payer: United Healthcare HMO Rider |
$862.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.00
|
| 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 WNDS 2.6-7.5 CM
|
Facility
|
IP
|
$1,724.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$1,551.60 |
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,379.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.60
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,551.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.80
|
| Rate for Payer: Multiplan Commercial |
$1,293.00
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
|
