|
HC DCMPRSN PERC W PRTL RMV OF LF INCL LMNTY
|
Facility
|
IP
|
$23,332.00
|
|
|
Service Code
|
CPT 62330
|
| Hospital Charge Code |
906811875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,666.40 |
| Max. Negotiated Rate |
$19,832.20 |
| Rate for Payer: Adventist Health Commercial |
$4,666.40
|
| Rate for Payer: Cash Price |
$10,499.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,332.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,332.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,332.80
|
| Rate for Payer: Galaxy Health WC |
$19,832.20
|
| Rate for Payer: Global Benefits Group Commercial |
$13,999.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,815.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,765.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,599.68
|
| Rate for Payer: Multiplan Commercial |
$18,665.60
|
| Rate for Payer: Networks By Design Commercial |
$15,165.80
|
| Rate for Payer: Prime Health Services Commercial |
$19,832.20
|
|
|
HC DCMPRSN PERC W PRTL RMV OF LF INCL LMNTY ADD IS LUMBAR
|
Facility
|
OP
|
$11,666.00
|
|
|
Service Code
|
CPT 62331
|
| Hospital Charge Code |
906811576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,333.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,333.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,916.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,416.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,749.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,486.07
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Cigna of CA HMO |
$7,466.24
|
| Rate for Payer: Cigna of CA PPO |
$8,632.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,916.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,916.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,916.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,166.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,666.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,666.40
|
| Rate for Payer: Galaxy Health WC |
$9,916.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,999.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,407.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,882.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,799.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,166.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,166.20
|
| Rate for Payer: Multiplan Commercial |
$9,332.80
|
| Rate for Payer: Networks By Design Commercial |
$7,582.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,916.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,999.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,833.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,833.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,833.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,833.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,916.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,916.10
|
| Rate for Payer: Vantage Medical Group Senior |
$9,916.10
|
|
|
HC DCMPRSN PERC W PRTL RMV OF LF INCL LMNTY ADD IS LUMBAR
|
Facility
|
IP
|
$11,666.00
|
|
|
Service Code
|
CPT 62331
|
| Hospital Charge Code |
906811576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,333.20 |
| Max. Negotiated Rate |
$9,916.10 |
| Rate for Payer: Adventist Health Commercial |
$2,333.20
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,166.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,666.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,666.40
|
| Rate for Payer: Galaxy Health WC |
$9,916.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,999.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,407.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,882.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,799.84
|
| Rate for Payer: Multiplan Commercial |
$9,332.80
|
| Rate for Payer: Networks By Design Commercial |
$7,582.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,916.10
|
|
|
HC D DIMER
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| 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 Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$112.94
|
| Rate for Payer: Blue Shield of California Commercial |
$57.15
|
| Rate for Payer: Blue Shield of California Commercial |
$170.76
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.20
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| 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 Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| 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 Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| 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 Commercial/Exchange |
$15.27
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| 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
|
$34.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900912043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| 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 Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.66
|
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Blue Shield of California Commercial |
$41.82
|
| Rate for Payer: Blue Shield of California Commercial |
$23.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.20
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| 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 All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| 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 Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC D-DIMER
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900912043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC DEB INFCTD SKIN LT 10% BDY SURF
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
902890275
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$997.05 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$692.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$938.40
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
|
|
HC DEB INFCTD SKIN LT 10% BDY SURF
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
902890275
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$480.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$181.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cigna of CA HMO |
$750.72
|
| Rate for Payer: Cigna of CA PPO |
$868.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$938.40
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC DEB MUSCLE AND OR FASCIA EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
900101492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC DEB MUSCLE AND OR FASCIA EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
900101492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,682.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,876.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,318.36
|
| 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 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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,682.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| 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/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,876.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$536.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,976.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| 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 |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,514.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,723.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,176.17
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,432.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,514.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| 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/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$646.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,723.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$731.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,919.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,006.17
|
| 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 |
$6,081.50
|
| 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 |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$3,024.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$2,570.40 |
| Rate for Payer: Adventist Health Commercial |
$604.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,116.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,209.60
|
| Rate for Payer: Galaxy Health WC |
$2,570.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,814.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,920.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,784.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.76
|
| Rate for Payer: Multiplan Commercial |
$2,419.20
|
| Rate for Payer: Networks By Design Commercial |
$1,965.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,570.40
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$3,024.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$604.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$402.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,570.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,663.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,268.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cigna of CA HMO |
$1,935.36
|
| Rate for Payer: Cigna of CA PPO |
$2,237.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,570.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,570.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,570.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,116.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,209.60
|
| Rate for Payer: Galaxy Health WC |
$2,570.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,814.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,920.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,784.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,116.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,116.80
|
| Rate for Payer: Multiplan Commercial |
$2,419.20
|
| Rate for Payer: Networks By Design Commercial |
$1,965.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,570.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,814.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,512.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,512.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,570.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,570.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,570.40
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| 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: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.68
|
| 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
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.68
|
| 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
|
456
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$103.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| 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: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,970.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| 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/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,323.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| 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 |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,970.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,323.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,875.22
|
| 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 DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
OP
|
$9,958.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$8,464.30 |
| Rate for Payer: Adventist Health Commercial |
$4,082.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,305.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,970.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| 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/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,323.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| 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 |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
IP
|
$9,958.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,970.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,323.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,875.22
|
| 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
|
|
