|
HC LASER TREATMENT
|
Facility
|
OP
|
$9,636.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,927.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| 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: Cash Price |
$4,336.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,263.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,964.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5,964.68
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,744.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$7,227.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| 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 LASER TREATMENT
|
Facility
|
IP
|
$9,636.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,744.12 |
| Max. Negotiated Rate |
$7,227.00 |
| Rate for Payer: Adventist Health Commercial |
$1,927.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.93
|
| Rate for Payer: Cash Price |
$4,336.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,523.57
|
| Rate for Payer: Heritage Provider Network Senior |
$6,523.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,744.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,409.00
|
| Rate for Payer: Multiplan Commercial |
$7,227.00
|
|
|
HC LASIX RENOGRAM
|
Facility
|
OP
|
$2,699.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$2,024.25 |
| Rate for Payer: Adventist Health Commercial |
$539.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$661.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$910.80
|
| Rate for Payer: Blue Shield of California EPN |
$517.94
|
| Rate for Payer: Cash Price |
$1,214.55
|
| Rate for Payer: Cash Price |
$1,214.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,754.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,754.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,670.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,670.68
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$284.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$2,024.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| 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
|
$2,699.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$488.52 |
| Max. Negotiated Rate |
$2,024.25 |
| Rate for Payer: Adventist Health Commercial |
$539.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.21
|
| Rate for Payer: Cash Price |
$1,214.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,827.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,827.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.75
|
| Rate for Payer: Multiplan Commercial |
$2,024.25
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
IP
|
$5,860.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,060.66 |
| Max. Negotiated Rate |
$4,395.00 |
| Rate for Payer: Adventist Health Commercial |
$1,172.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,025.82
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,967.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,967.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,060.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,465.00
|
| Rate for Payer: Multiplan Commercial |
$4,395.00
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
OP
|
$5,860.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,172.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,025.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,809.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,967.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,967.22
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,824.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,060.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,465.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$4,395.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,127.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,957.83
|
| 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 LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$966.75 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$885.54
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$872.65
|
| Rate for Payer: Heritage Provider Network Senior |
$872.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.25
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$885.54
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$837.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$872.65
|
| Rate for Payer: Heritage Provider Network Senior |
$872.65
|
| Rate for Payer: Humana Medicare |
$498.20
|
| 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: Kaiser Permanente of CA Commercial |
$621.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$468.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$430.65
|
| 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 20.1-30.0 CM
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$1,143.75 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,047.68
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,032.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,032.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.25
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,047.68
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$991.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,032.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,032.42
|
| Rate for Payer: Humana Medicare |
$784.71
|
| 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: Kaiser Permanente of CA Commercial |
$735.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$553.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$509.50
|
| 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 2.6-7.5CM
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.46 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$525.56
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$517.90
|
| Rate for Payer: Heritage Provider Network Senior |
$517.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$573.75
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$525.56
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$497.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$517.90
|
| Rate for Payer: Heritage Provider Network Senior |
$517.90
|
| Rate for Payer: Humana Medicare |
$498.20
|
| 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: Kaiser Permanente of CA Commercial |
$368.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$573.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$277.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$255.59
|
| 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
|
$992.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$681.50
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$644.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$671.58
|
| Rate for Payer: Heritage Provider Network Senior |
$671.58
|
| Rate for Payer: Humana Medicare |
$498.20
|
| 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: Kaiser Permanente of CA Commercial |
$478.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$360.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$331.43
|
| 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
|
$992.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.55 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$681.50
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$671.58
|
| Rate for Payer: Heritage Provider Network Senior |
$671.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
|
|
HC LAY CLOS OF WND GT 30.0 CM
|
Facility
|
OP
|
$1,761.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
900501643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$352.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,209.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,144.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.20
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$848.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$1,320.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$639.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$588.35
|
| 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 LAY CLOS OF WND GT 30.0 CM
|
Facility
|
IP
|
$1,761.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
900501643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.74 |
| Max. Negotiated Rate |
$1,320.75 |
| Rate for Payer: Adventist Health Commercial |
$352.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,209.81
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.25
|
| Rate for Payer: Multiplan Commercial |
$1,320.75
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.54 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.23
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$508.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$529.41
|
| Rate for Payer: Heritage Provider Network Senior |
$529.41
|
| Rate for Payer: Humana Medicare |
$498.20
|
| 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: Kaiser Permanente of CA Commercial |
$376.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$283.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$261.27
|
| 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
|
$782.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.54 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.23
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$529.41
|
| Rate for Payer: Heritage Provider Network Senior |
$529.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.50
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
|
|
HC LAY CLOS OF WND LT 2.5 CM SCALP
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$147.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$504.94
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$477.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$497.60
|
| Rate for Payer: Heritage Provider Network Senior |
$497.60
|
| Rate for Payer: Humana Medicare |
$498.20
|
| 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: Kaiser Permanente of CA Commercial |
$354.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$551.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$245.56
|
| 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
|
$735.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.04 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: Adventist Health Commercial |
$147.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$504.94
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$497.60
|
| Rate for Payer: Heritage Provider Network Senior |
$497.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$551.25
|
|
|
HC LAY CLOS OF WNDS 12.6- 20.0 CM
|
Facility
|
IP
|
$1,099.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
900501416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.92 |
| Max. Negotiated Rate |
$824.25 |
| Rate for Payer: Adventist Health Commercial |
$219.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$755.01
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.02
|
| Rate for Payer: Heritage Provider Network Senior |
$744.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.75
|
| Rate for Payer: Multiplan Commercial |
$824.25
|
|
|
HC LAY CLOS OF WNDS 12.6- 20.0 CM
|
Facility
|
OP
|
$1,099.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
900501416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$219.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$755.01
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$714.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.02
|
| Rate for Payer: Heritage Provider Network Senior |
$744.02
|
| Rate for Payer: Humana Medicare |
$784.71
|
| 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: Kaiser Permanente of CA Commercial |
$529.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$824.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$399.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$367.18
|
| 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
|
OP
|
$1,531.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$306.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,051.80
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$995.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,036.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,036.49
|
| Rate for Payer: Humana Medicare |
$498.20
|
| 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: Kaiser Permanente of CA Commercial |
$737.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$1,148.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$555.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$511.51
|
| 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
|
$1,531.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$1,148.25 |
| Rate for Payer: Adventist Health Commercial |
$306.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,051.80
|
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,036.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,036.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.75
|
| Rate for Payer: Multiplan Commercial |
$1,148.25
|
|
|
HC LAY CLOS OF WNDS 20.1-30.0 CM
|
Facility
|
IP
|
$1,767.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
900501525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$319.83 |
| Max. Negotiated Rate |
$1,325.25 |
| Rate for Payer: Adventist Health Commercial |
$353.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,213.93
|
| Rate for Payer: Cash Price |
$795.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,196.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,196.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.75
|
| Rate for Payer: Multiplan Commercial |
$1,325.25
|
|
