|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
OP
|
$11,671.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$879.07 |
| Max. Negotiated Rate |
$10,503.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| 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: BCBS Transplant Transplant |
$7,002.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,341.06
|
| Rate for Payer: Blue Shield of California EPN |
$5,707.12
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,336.80
|
| Rate for Payer: Cigna of CA HMO |
$7,469.44
|
| Rate for Payer: Cigna of CA PPO |
$8,636.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| 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 |
$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: Health Plan of Nevada - Sierra Transplant Other |
$8,753.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: IEHP medi-cal |
$1,450.47
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Innovage PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,784.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,334.20
|
| 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 |
$8,753.25
|
| Rate for Payer: Networks By Design Commercial |
$7,586.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,920.35
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,002.60
|
| Rate for Payer: Riverside University Health MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,002.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,002.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,835.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,835.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,835.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,835.50
|
| 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 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: 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
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
OP
|
$11,671.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,503.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| 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: BCBS Transplant Transplant |
$7,002.60
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,336.80
|
| Rate for Payer: Cigna of CA PPO |
$8,636.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| 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 |
$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: Health Plan of Nevada - Sierra Transplant Other |
$8,753.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Innovage PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,784.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,334.20
|
| 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 |
$8,753.25
|
| Rate for Payer: Networks By Design Commercial |
$7,586.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,920.35
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,002.60
|
| Rate for Payer: Riverside University Health MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,002.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,835.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,835.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,835.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,835.50
|
| 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 SKIN & SUBQ TISSUE
|
Facility
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$428.60 |
| Max. Negotiated Rate |
$1,928.70 |
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$428.60 |
| Max. Negotiated Rate |
$1,928.70 |
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$428.60 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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: BCBS Transplant Transplant |
$1,285.80
|
| 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 |
$498.20
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: Cigna of CA PPO |
$1,585.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,607.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,285.80
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.80
|
| 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 |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$428.60 |
| Max. Negotiated Rate |
$1,928.70 |
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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: BCBS Transplant Transplant |
$1,285.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,347.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,047.93
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: Cigna of CA HMO |
$1,371.52
|
| Rate for Payer: Cigna of CA PPO |
$1,585.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,607.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,071.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,071.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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: BCBS Transplant Transplant |
$1,285.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,347.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,047.93
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: Cigna of CA HMO |
$1,371.52
|
| Rate for Payer: Cigna of CA PPO |
$1,585.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,607.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,071.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,071.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.60 |
| Max. Negotiated Rate |
$1,928.70 |
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$428.60 |
| Max. Negotiated Rate |
$1,928.70 |
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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: BCBS Transplant Transplant |
$1,285.80
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: Cigna of CA PPO |
$1,585.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,607.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,285.80
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,071.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,071.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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: BCBS Transplant Transplant |
$1,285.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,347.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,047.93
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,714.40
|
| Rate for Payer: Cigna of CA HMO |
$1,371.52
|
| Rate for Payer: Cigna of CA PPO |
$1,585.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,928.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,607.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DEB SUBQ AND DERMIS TISSUE EACH ADDL 20 SQ CM
|
Facility
OP
|
$532.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
900101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$452.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$292.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$292.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$319.20
|
| Rate for Payer: Blue Shield of California Commercial |
$334.63
|
| Rate for Payer: Blue Shield of California EPN |
$260.15
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Central Health Plan Commercial |
$425.60
|
| Rate for Payer: Cigna of CA HMO |
$340.48
|
| Rate for Payer: Cigna of CA PPO |
$393.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$212.80
|
| Rate for Payer: Galaxy Health WC |
$452.20
|
| Rate for Payer: Global Benefits Group Commercial |
$319.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$478.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$399.00
|
| Rate for Payer: IEHP medi-cal |
$186.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: Networks By Design Commercial |
$345.80
|
| Rate for Payer: Prime Health Services Commercial |
$452.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$212.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.00
|
| Rate for Payer: United Healthcare All Other HMO |
$266.00
|
| Rate for Payer: United Healthcare HMO Rider |
$266.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$452.20
|
| Rate for Payer: Vantage Medical Group Senior |
$452.20
|
|
|
HC DEB SUBQ AND DERMIS TISSUE EACH ADDL 20 SQ CM
|
Facility
IP
|
$532.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
900101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Central Health Plan Commercial |
$425.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.80
|
| Rate for Payer: Galaxy Health WC |
$452.20
|
| Rate for Payer: Global Benefits Group Commercial |
$319.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$478.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: Networks By Design Commercial |
$345.80
|
| Rate for Payer: Prime Health Services Commercial |
$452.20
|
|
|
HC DECALCIFICATION PG
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
903800209
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: BCBS Transplant Transplant |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.65
|
| Rate for Payer: Blue Shield of California EPN |
$6.80
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.50
|
| Rate for Payer: IEHP medi-cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: Riverside University Health MISP |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
HC DECALCIFICATION PG
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
903800209
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
|
HC DECALCIFICATION PROCEDURE
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
903800028
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: BCBS Transplant Transplant |
$21.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21.63
|
| Rate for Payer: Blue Shield of California EPN |
$17.01
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.25
|
| Rate for Payer: IEHP medi-cal |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: Riverside University Health MISP |
$14.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC DECALCIFICATION PROCEDURE
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
903800028
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
940100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
949000302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$964.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: IEHP medi-cal |
$698.18
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Innovage PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$964.80
|
| Rate for Payer: Riverside University Health MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| 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 |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
945100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$964.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: IEHP medi-cal |
$698.18
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Innovage PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$964.80
|
| Rate for Payer: Riverside University Health MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| 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 |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
901200077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
945000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$964.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: IEHP medi-cal |
$698.18
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Innovage PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$964.80
|
| Rate for Payer: Riverside University Health MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| 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 |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
947200110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
