|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO |
$203.52
|
| Rate for Payer: Cigna of CA PPO |
$235.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$222.60
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.30
|
| Rate for Payer: Vantage Medical Group Senior |
$270.30
|
|
|
HC D & C 1ST TRIMESTER
|
Facility
|
IP
|
$7,124.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,424.80 |
| Max. Negotiated Rate |
$6,055.40 |
| Rate for Payer: Adventist Health Commercial |
$1,424.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,849.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,849.60
|
| Rate for Payer: Galaxy Health WC |
$6,055.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,274.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,409.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,709.76
|
| Rate for Payer: Multiplan Commercial |
$5,699.20
|
| Rate for Payer: Networks By Design Commercial |
$4,630.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,055.40
|
|
|
HC D & C 1ST TRIMESTER
|
Facility
|
OP
|
$7,124.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$665.55 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,424.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cigna of CA HMO |
$4,559.36
|
| Rate for Payer: Cigna of CA PPO |
$5,271.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,055.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,274.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$665.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$752.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,709.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$5,699.20
|
| Rate for Payer: Networks By Design Commercial |
$4,630.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,055.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,274.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,562.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,562.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,562.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,562.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC D & C 2ND TRIMESTER
|
Facility
|
IP
|
$7,124.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
910400030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,424.80 |
| Max. Negotiated Rate |
$6,055.40 |
| Rate for Payer: Adventist Health Commercial |
$1,424.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,849.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,849.60
|
| Rate for Payer: Galaxy Health WC |
$6,055.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,274.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,409.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,709.76
|
| Rate for Payer: Multiplan Commercial |
$5,699.20
|
| Rate for Payer: Networks By Design Commercial |
$4,630.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,055.40
|
|
|
HC D & C 2ND TRIMESTER
|
Facility
|
OP
|
$7,124.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
910400030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.33 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,424.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cigna of CA HMO |
$4,559.36
|
| Rate for Payer: Cigna of CA PPO |
$5,271.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,055.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,274.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,709.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$5,699.20
|
| Rate for Payer: Networks By Design Commercial |
$4,630.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,055.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,274.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,562.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,562.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,562.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,562.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC D DIMER
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC D DIMER
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$100.48 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.48
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC DEB OF FX SKIN MUSCLE
|
Facility
|
OP
|
$12,404.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$536.18 |
| Max. Negotiated Rate |
$10,543.40 |
| Rate for Payer: Adventist Health Commercial |
$2,480.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,581.80
|
| Rate for Payer: Cash Price |
$5,581.80
|
| Rate for Payer: Cash Price |
$5,581.80
|
| Rate for Payer: Cigna of CA HMO |
$7,938.56
|
| Rate for Payer: Cigna of CA PPO |
$9,178.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$10,543.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,442.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,976.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$9,923.20
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$8,062.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,543.40
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,442.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,202.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,202.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,202.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,202.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC DEB OF FX SKIN MUSCLE
|
Facility
|
IP
|
$12,404.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,480.80 |
| Max. Negotiated Rate |
$10,543.40 |
| Rate for Payer: Adventist Health Commercial |
$2,480.80
|
| Rate for Payer: Cash Price |
$5,581.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,961.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,961.60
|
| Rate for Payer: Galaxy Health WC |
$10,543.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,442.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,725.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,678.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,976.96
|
| Rate for Payer: Multiplan Commercial |
$9,923.20
|
| Rate for Payer: Networks By Design Commercial |
$8,062.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,543.40
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
OP
|
$12,163.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$646.73 |
| Max. Negotiated Rate |
$10,338.55 |
| Rate for Payer: Adventist Health Commercial |
$2,432.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,473.35
|
| Rate for Payer: Cash Price |
$5,473.35
|
| Rate for Payer: Cash Price |
$5,473.35
|
| Rate for Payer: Cigna of CA HMO |
$7,784.32
|
| Rate for Payer: Cigna of CA PPO |
$9,000.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$10,338.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,297.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$646.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,919.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$9,730.40
|
| Rate for Payer: Networks By Design Commercial |
$7,905.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,338.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,297.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,297.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
IP
|
$12,163.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,432.60 |
| Max. Negotiated Rate |
$10,338.55 |
| Rate for Payer: Adventist Health Commercial |
$2,432.60
|
| Rate for Payer: Cash Price |
$5,473.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,865.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.20
|
| Rate for Payer: Galaxy Health WC |
$10,338.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,297.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,634.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,528.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,919.12
|
| Rate for Payer: Multiplan Commercial |
$9,730.40
|
| Rate for Payer: Networks By Design Commercial |
$7,905.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,338.55
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna of CA HMO |
$161.28
|
| Rate for Payer: Cigna of CA PPO |
$186.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.00
|
| Rate for Payer: United Healthcare All Other HMO |
$126.00
|
| Rate for Payer: United Healthcare HMO Rider |
$126.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
OP
|
$9,958.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$8,464.30 |
| Rate for Payer: Adventist Health Commercial |
$1,991.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,481.10
|
| Rate for Payer: Cash Price |
$4,481.10
|
| Rate for Payer: Cash Price |
$4,481.10
|
| Rate for Payer: Cash Price |
$4,481.10
|
| Rate for Payer: Cigna of CA HMO |
$6,373.12
|
| Rate for Payer: Cigna of CA PPO |
$7,368.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$8,464.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,641.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$7,966.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$6,472.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,464.30
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,974.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,979.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,979.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,979.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,979.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
IP
|
$9,958.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,991.60 |
| Max. Negotiated Rate |
$8,464.30 |
| Rate for Payer: Adventist Health Commercial |
$1,991.60
|
| Rate for Payer: Cash Price |
$4,481.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,983.20
|
| Rate for Payer: Galaxy Health WC |
$8,464.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,641.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,794.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,164.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.92
|
| Rate for Payer: Multiplan Commercial |
$7,966.40
|
| Rate for Payer: Networks By Design Commercial |
$6,472.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,464.30
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$594.00 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Adventist Health Commercial |
$594.00
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,188.00
|
| Rate for Payer: Galaxy Health WC |
$2,524.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,782.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,980.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,131.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,838.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.80
|
| Rate for Payer: Multiplan Commercial |
$2,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,524.50
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$594.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cigna of CA HMO |
$1,900.80
|
| Rate for Payer: Cigna of CA PPO |
$2,197.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$2,524.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,782.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,980.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$2,376.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,524.50
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,782.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,485.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,485.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,485.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
|
OP
|
$11,408.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.96 |
| Max. Negotiated Rate |
$9,696.80 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna of CA HMO |
$7,301.12
|
| Rate for Payer: Cigna of CA PPO |
$8,441.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$9,696.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,844.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,609.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,737.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$9,126.40
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$7,415.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,696.80
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,844.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,704.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,704.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,704.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,704.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
|
IP
|
$11,408.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$9,696.80 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,563.20
|
| Rate for Payer: Galaxy Health WC |
$9,696.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,844.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,609.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,346.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,061.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,737.92
|
| Rate for Payer: Multiplan Commercial |
$9,126.40
|
| Rate for Payer: Networks By Design Commercial |
$7,415.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,696.80
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$2,408.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.35 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna of CA HMO |
$1,541.12
|
| Rate for Payer: Cigna of CA PPO |
$1,781.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,444.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,204.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
IP
|
$2,408.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$2,046.80 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,490.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
IP
|
$2,408.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$2,046.80 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,490.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$2,408.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna of CA HMO |
$1,541.12
|
| Rate for Payer: Cigna of CA PPO |
$1,781.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,444.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC DECALCIFICATION PG
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
903800209
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$11.20
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
