|
HC DEB OF FX SKIN MUSCLE
|
Facility
|
OP
|
$12,690.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,421.00 |
| 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 |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,614.00
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,152.00
|
| Rate for Payer: Cigna of CA PPO |
$9,390.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$10,786.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,614.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,421.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,538.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$9,517.50
|
| Rate for Payer: Networks By Design Commercial |
$8,248.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,786.50
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,614.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,345.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,345.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,345.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,345.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC DEB OF FX SKIN MUSCLE
|
Facility
|
IP
|
$12,690.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,538.00 |
| Max. Negotiated Rate |
$11,421.00 |
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,152.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,076.00
|
| Rate for Payer: Galaxy Health WC |
$10,786.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,614.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,421.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,834.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,538.00
|
| Rate for Payer: Multiplan Commercial |
$9,517.50
|
| Rate for Payer: Networks By Design Commercial |
$8,248.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,786.50
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
OP
|
$12,443.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$731.42 |
| Max. Negotiated Rate |
$11,198.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,550.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,465.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,826.65
|
| Rate for Payer: Blue Shield of California EPN |
$6,084.63
|
| Rate for Payer: Caremore Medicare Advantage |
$3,550.26
|
| Rate for Payer: Cash Price |
$5,599.35
|
| Rate for Payer: Cash Price |
$5,599.35
|
| Rate for Payer: Central Health Plan Commercial |
$9,954.40
|
| Rate for Payer: Cigna of CA PPO |
$9,207.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$10,576.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,465.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,198.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,332.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,857.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,488.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$9,332.25
|
| Rate for Payer: Networks By Design Commercial |
$8,087.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,576.55
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health System MISP |
$3,905.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,465.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,465.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
IP
|
$12,443.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,488.60 |
| Max. Negotiated Rate |
$11,198.70 |
| Rate for Payer: Cash Price |
$5,599.35
|
| Rate for Payer: Central Health Plan Commercial |
$9,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,977.20
|
| Rate for Payer: Galaxy Health WC |
$10,576.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,465.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,198.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,740.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,488.60
|
| Rate for Payer: Multiplan Commercial |
$9,332.25
|
| Rate for Payer: Networks By Design Commercial |
$8,087.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,576.55
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,943.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,257.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,257.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,372.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,438.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.34
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Cigna of CA HMO |
$1,463.68
|
| Rate for Payer: Cigna of CA PPO |
$1,692.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,943.95
|
| Rate for Payer: Dignity Health Media |
$1,943.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,943.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$914.80
|
| Rate for Payer: Galaxy Health WC |
$1,943.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,372.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,058.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,715.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$800.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,525.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.40
|
| Rate for Payer: Multiplan Commercial |
$1,715.25
|
| Rate for Payer: Networks By Design Commercial |
$1,486.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.95
|
| Rate for Payer: Riverside University Health System MISP |
$914.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,372.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,143.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,143.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,943.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,943.95
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.40 |
| Max. Negotiated Rate |
$2,058.30 |
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,829.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.80
|
| Rate for Payer: Galaxy Health WC |
$1,943.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,372.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,058.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,525.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$871.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.40
|
| Rate for Payer: Multiplan Commercial |
$1,715.25
|
| Rate for Payer: Networks By Design Commercial |
$1,486.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.95
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$155.40
|
| Rate for Payer: Blue Shield of California Commercial |
$162.91
|
| Rate for Payer: Blue Shield of California EPN |
$126.65
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: Cigna of CA HMO |
$165.76
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$194.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$129.50
|
| Rate for Payer: United Healthcare HMO Rider |
$129.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
IP
|
$10,187.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$2,037.40 |
| Max. Negotiated Rate |
$9,168.30 |
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,074.80
|
| Rate for Payer: Galaxy Health WC |
$8,658.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,168.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,794.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,881.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.40
|
| Rate for Payer: Multiplan Commercial |
$7,640.25
|
| Rate for Payer: Networks By Design Commercial |
$6,621.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,658.95
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
OP
|
$10,187.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$9,168.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,112.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,149.60
|
| Rate for Payer: Cigna of CA PPO |
$7,538.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$8,658.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,168.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,640.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,794.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$7,640.25
|
| Rate for Payer: Networks By Design Commercial |
$6,621.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,658.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
OP
|
$10,187.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$9,168.30 |
| 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 |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,112.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,149.60
|
| Rate for Payer: Cigna of CA PPO |
$7,538.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$8,658.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,168.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,640.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,794.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$7,640.25
|
| Rate for Payer: Networks By Design Commercial |
$6,621.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,658.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,093.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,093.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,093.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,093.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
IP
|
$10,187.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,037.40 |
| Max. Negotiated Rate |
$9,168.30 |
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,074.80
|
| Rate for Payer: Galaxy Health WC |
$8,658.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,168.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,794.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,881.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.40
|
| Rate for Payer: Multiplan Commercial |
$7,640.25
|
| Rate for Payer: Networks By Design Commercial |
$6,621.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,658.95
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
IP
|
$10,187.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,037.40 |
| Max. Negotiated Rate |
$9,168.30 |
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,074.80
|
| Rate for Payer: Galaxy Health WC |
$8,658.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,168.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,794.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,881.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.40
|
| Rate for Payer: Multiplan Commercial |
$7,640.25
|
| Rate for Payer: Networks By Design Commercial |
$6,621.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,658.95
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
OP
|
$10,187.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$9,168.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,112.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,407.62
|
| Rate for Payer: Blue Shield of California EPN |
$4,981.44
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,149.60
|
| Rate for Payer: Cigna of CA HMO |
$6,519.68
|
| Rate for Payer: Cigna of CA PPO |
$7,538.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$8,658.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,168.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,640.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,794.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$7,640.25
|
| Rate for Payer: Networks By Design Commercial |
$6,621.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,658.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,093.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,093.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,093.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,093.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC DEBRIDE SKIN INFECT EA ADDL10%
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
900101490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC DEBRIDE SKIN INFECT EA ADDL10%
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
900101490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$455.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$496.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Media |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$621.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Riverside University Health System MISP |
$331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$528.60 |
| Max. Negotiated Rate |
$2,378.70 |
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.20
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,006.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$2,643.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.81 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,585.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: Cigna of CA PPO |
$1,955.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,982.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,294.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,585.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$528.60 |
| Max. Negotiated Rate |
$2,378.70 |
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.20
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,006.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$2,643.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,585.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,662.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,292.43
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: Cigna of CA HMO |
$1,691.52
|
| Rate for Payer: Cigna of CA PPO |
$1,955.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,982.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,294.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,585.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,321.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
902890010
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$528.60 |
| Max. Negotiated Rate |
$2,378.70 |
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.20
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,006.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$528.60 |
| Max. Negotiated Rate |
$2,378.70 |
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.20
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,006.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$2,643.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.81 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,585.80
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: Cigna of CA PPO |
$1,955.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,982.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,585.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,321.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$2,643.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
902890010
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,585.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,662.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,292.43
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: Cigna of CA HMO |
$1,691.52
|
| Rate for Payer: Cigna of CA PPO |
$1,955.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,982.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,294.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,585.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,321.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
|
IP
|
$11,671.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,334.20 |
| Max. Negotiated Rate |
$10,503.90 |
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,336.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,668.40
|
| Rate for Payer: Galaxy Health WC |
$9,920.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,002.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,503.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,784.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,446.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,334.20
|
| Rate for Payer: Multiplan Commercial |
$8,753.25
|
| Rate for Payer: Networks By Design Commercial |
$7,586.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,920.35
|
|
