|
HC DEBRIDE SKIN INFECT EA ADDL10%
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
900101490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.09
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| 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: 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: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.92
|
| Rate for Payer: InnovAge PACE Commercial |
$547.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| 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 |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| 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 |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$2,888.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
902890010
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,184.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,310.40
|
| Rate for Payer: Cigna of CA HMO |
$1,848.32
|
| Rate for Payer: Cigna of CA PPO |
$2,137.12
|
| 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 |
$2,454.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,732.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,599.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.30
|
| 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 |
$577.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$2,166.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,877.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,454.80
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,732.80
|
| 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 |
$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 & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$2,888.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$577.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$777.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,764.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,152.31
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,310.40
|
| Rate for Payer: Cigna of CA HMO |
$1,848.32
|
| Rate for Payer: Cigna of CA PPO |
$2,137.12
|
| 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 |
$2,454.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,732.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,599.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$269.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.30
|
| 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 |
$577.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$2,166.00
|
| Rate for Payer: Networks By Design Commercial |
$1,877.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Prime Health Services Commercial |
$2,454.80
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,732.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,444.00
|
| 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 & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$2,888.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$577.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,310.40
|
| Rate for Payer: Cigna of CA HMO |
$1,848.32
|
| Rate for Payer: Cigna of CA PPO |
$2,137.12
|
| 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 |
$2,454.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,732.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,599.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.30
|
| 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 |
$577.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$2,166.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,877.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,454.80
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,732.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,444.00
|
| 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 & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$2,888.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$577.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$777.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,310.40
|
| Rate for Payer: Cigna of CA HMO |
$1,848.32
|
| Rate for Payer: Cigna of CA PPO |
$2,137.12
|
| 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 |
$2,454.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,732.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,599.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$269.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.30
|
| 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 |
$577.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$2,166.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,877.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,454.80
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,732.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| 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: 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 & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$2,888.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$577.60 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Adventist Health Commercial |
$577.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,155.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,155.20
|
| Rate for Payer: Galaxy Health WC |
$2,454.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,732.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,599.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,787.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.60
|
| Rate for Payer: Multiplan Commercial |
$2,166.00
|
| Rate for Payer: Networks By Design Commercial |
$1,877.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,454.80
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$2,888.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.60 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Adventist Health Commercial |
$577.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,155.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,155.20
|
| Rate for Payer: Galaxy Health WC |
$2,454.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,732.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,599.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,787.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.60
|
| Rate for Payer: Multiplan Commercial |
$2,166.00
|
| Rate for Payer: Networks By Design Commercial |
$1,877.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,454.80
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$2,888.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
902890010
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$577.60 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Adventist Health Commercial |
$577.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,155.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,155.20
|
| Rate for Payer: Galaxy Health WC |
$2,454.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,732.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,599.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,787.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.60
|
| Rate for Payer: Multiplan Commercial |
$2,166.00
|
| Rate for Payer: Networks By Design Commercial |
$1,877.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,454.80
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$2,888.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$577.60 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Adventist Health Commercial |
$577.60
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,155.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,155.20
|
| Rate for Payer: Galaxy Health WC |
$2,454.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,732.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,599.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,787.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.60
|
| Rate for Payer: Multiplan Commercial |
$2,166.00
|
| Rate for Payer: Networks By Design Commercial |
$1,877.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,454.80
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
|
OP
|
$15,435.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,891.50 |
| Rate for Payer: Adventist Health Commercial |
$6,328.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Central Health Plan Commercial |
$12,348.00
|
| Rate for Payer: Cigna of CA HMO |
$9,878.40
|
| Rate for Payer: Cigna of CA PPO |
$11,421.90
|
| 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 |
$13,119.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,891.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,295.15
|
| 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 |
$3,087.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$11,576.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$10,032.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$13,119.75
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,261.00
|
| 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 |
$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
|
$15,435.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,087.00 |
| Max. Negotiated Rate |
$13,891.50 |
| Rate for Payer: Adventist Health Commercial |
$3,087.00
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Central Health Plan Commercial |
$12,348.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,174.00
|
| Rate for Payer: Galaxy Health WC |
$13,119.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,891.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,295.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,880.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,554.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,087.00
|
| Rate for Payer: Multiplan Commercial |
$11,576.25
|
| Rate for Payer: Networks By Design Commercial |
$10,032.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,119.75
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
|
OP
|
$15,435.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,891.50 |
| Rate for Payer: Adventist Health Commercial |
$3,087.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Central Health Plan Commercial |
$12,348.00
|
| Rate for Payer: Cigna of CA HMO |
$9,878.40
|
| Rate for Payer: Cigna of CA PPO |
$11,421.90
|
| 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 |
$13,119.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,891.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,295.15
|
| 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 |
$3,087.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$11,576.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$10,032.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$13,119.75
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,717.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,717.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,717.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,717.50
|
| 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
|
$15,435.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,087.00 |
| Max. Negotiated Rate |
$13,891.50 |
| Rate for Payer: Adventist Health Commercial |
$3,087.00
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: Central Health Plan Commercial |
$12,348.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,174.00
|
| Rate for Payer: Galaxy Health WC |
$13,119.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,891.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,295.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,880.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,554.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,087.00
|
| Rate for Payer: Multiplan Commercial |
$11,576.25
|
| Rate for Payer: Networks By Design Commercial |
$10,032.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,119.75
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
IP
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$468.20 |
| Max. Negotiated Rate |
$2,106.90 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.40
|
| Rate for Payer: EPIC Health Plan Senior |
$936.40
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,449.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.20
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
IP
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$468.20 |
| Max. Negotiated Rate |
$2,106.90 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.40
|
| Rate for Payer: EPIC Health Plan Senior |
$936.40
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,449.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.20
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$178.66 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: Cigna of CA HMO |
$1,498.24
|
| Rate for Payer: Cigna of CA PPO |
$1,732.34
|
| 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 |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| 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 |
$468.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| 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: 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
|
OP
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.66 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,430.35
|
| Rate for Payer: Blue Shield of California EPN |
$934.06
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: Cigna of CA HMO |
$1,498.24
|
| Rate for Payer: Cigna of CA PPO |
$1,732.34
|
| 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 |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| 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 |
$468.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,170.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,170.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,170.50
|
| 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
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.20 |
| Max. Negotiated Rate |
$2,106.90 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.40
|
| Rate for Payer: EPIC Health Plan Senior |
$936.40
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,449.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.20
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
IP
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$468.20 |
| Max. Negotiated Rate |
$2,106.90 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.40
|
| Rate for Payer: EPIC Health Plan Senior |
$936.40
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,449.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.20
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$178.66 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,430.35
|
| Rate for Payer: Blue Shield of California EPN |
$934.06
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: Cigna of CA HMO |
$1,498.24
|
| Rate for Payer: Cigna of CA PPO |
$1,732.34
|
| 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 |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| 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 |
$468.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.60
|
| 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 DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$197.35 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$959.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: Cigna of CA HMO |
$1,498.24
|
| Rate for Payer: Cigna of CA PPO |
$1,732.34
|
| 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 |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| 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 |
$468.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.60
|
| 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 |
$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
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$468.20 |
| Max. Negotiated Rate |
$2,106.90 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.40
|
| Rate for Payer: EPIC Health Plan Senior |
$936.40
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,449.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.20
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$2,341.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.35 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: Cigna of CA HMO |
$1,498.24
|
| Rate for Payer: Cigna of CA PPO |
$1,732.34
|
| 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 |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| 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 |
$468.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,170.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,170.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,170.50
|
| 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 SUBQ AND DERMIS TISSUE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
900101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$140.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$598.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$528.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$340.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$413.46
|
| Rate for Payer: Blue Shield of California Commercial |
$430.14
|
| Rate for Payer: Blue Shield of California EPN |
$280.90
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| Rate for Payer: Cigna of CA HMO |
$450.56
|
| Rate for Payer: Cigna of CA PPO |
$520.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$598.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$598.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$598.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.60
|
| Rate for Payer: EPIC Health Plan Senior |
$281.60
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$633.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.97
|
| Rate for Payer: InnovAge PACE Commercial |
$352.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.80
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
| Rate for Payer: Riverside University Health System MISP |
$281.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$422.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.00
|
| Rate for Payer: United Healthcare All Other HMO |
$352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$352.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$598.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$598.40
|
| Rate for Payer: Vantage Medical Group Senior |
$598.40
|
|
|
HC DEB SUBQ AND DERMIS TISSUE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
900101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Adventist Health Commercial |
$140.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.60
|
| Rate for Payer: EPIC Health Plan Senior |
$281.60
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
|
