|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$177.92 |
| Max. Negotiated Rate |
$737.25 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$675.32
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$665.49
|
| Rate for Payer: Heritage Provider Network Senior |
$665.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.75
|
| Rate for Payer: Multiplan Commercial |
$737.25
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$675.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$835.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$540.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$610.44
|
| Rate for Payer: Blue Shield of California EPN |
$577.02
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$638.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$835.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$835.55
|
| Rate for Payer: Dignity Health Senior |
$835.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$608.48
|
| Rate for Payer: Heritage Provider Network Senior |
$608.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$473.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.75
|
| Rate for Payer: Multiplan Commercial |
$737.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$491.50
|
| Rate for Payer: TriValley Medical Group Senior |
$491.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$835.55
|
| Rate for Payer: Vantage Medical Group Senior |
$835.55
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.92 |
| Max. Negotiated Rate |
$737.25 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$675.32
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$665.49
|
| Rate for Payer: Heritage Provider Network Senior |
$665.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.75
|
| Rate for Payer: Multiplan Commercial |
$737.25
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$123.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Senior |
$105.00
|
| 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 SKIN MUSCLE & BONE
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.46 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Adventist Health Commercial |
$355.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,220.11
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,202.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,202.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$1,332.00
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$355.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,220.11
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,154.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,202.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,202.35
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| 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: Kaiser Permanente of CA Commercial |
$856.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$1,332.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$644.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$593.36
|
| 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
|
$1,776.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$355.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,220.11
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,154.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,099.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$315.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$1,332.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| 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
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.46 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Adventist Health Commercial |
$355.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,220.11
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,202.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,202.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$1,332.00
|
|
|
HC DEBRIDE SKIN INFECT EA ADDL10%
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
900101490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$58.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$181.95
|
| Rate for Payer: Blue Shield of California EPN |
$171.99
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$190.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.05
|
| Rate for Payer: Dignity Health Senior |
$249.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.37
|
| Rate for Payer: Heritage Provider Network Senior |
$181.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$141.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.25
|
| Rate for Payer: Multiplan Commercial |
$219.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$146.50
|
| Rate for Payer: TriValley Medical Group Senior |
$146.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.05
|
| Rate for Payer: Vantage Medical Group Senior |
$249.05
|
|
|
HC DEBRIDE SKIN INFECT EA ADDL10%
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
900101490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.03 |
| Max. Negotiated Rate |
$219.75 |
| Rate for Payer: Adventist Health Commercial |
$58.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.29
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.36
|
| Rate for Payer: Heritage Provider Network Senior |
$198.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.25
|
| Rate for Payer: Multiplan Commercial |
$219.75
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Humana Medicare |
$784.71
|
| 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: Kaiser Permanente of CA Commercial |
$332.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$230.19
|
| 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
|
$689.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.87
|
| Rate for Payer: Blue Shield of California EPN |
$404.44
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$426.49
|
| Rate for Payer: Heritage Provider Network Senior |
$426.49
|
| Rate for Payer: Humana Medicare |
$784.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$244.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,490.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.18
|
| Rate for Payer: TriValley Medical Group Senior |
$863.18
|
| 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
|
$983.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.92 |
| Max. Negotiated Rate |
$737.25 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$675.32
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$665.49
|
| Rate for Payer: Heritage Provider Network Senior |
$665.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.75
|
| Rate for Payer: Multiplan Commercial |
$737.25
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$675.32
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$638.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$665.49
|
| Rate for Payer: Heritage Provider Network Senior |
$665.49
|
| Rate for Payer: Humana Medicare |
$879.07
|
| 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: Kaiser Permanente of CA Commercial |
$473.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$737.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$356.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.42
|
| 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
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.87
|
| Rate for Payer: Blue Shield of California EPN |
$404.44
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$426.49
|
| Rate for Payer: Heritage Provider Network Senior |
$426.49
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$548.02
|
| 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
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$332.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$230.19
|
| 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
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.87
|
| Rate for Payer: Blue Shield of California EPN |
$404.44
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$426.49
|
| Rate for Payer: Heritage Provider Network Senior |
$426.49
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$498.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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
|
$614.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
900101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$460.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$381.29
|
| Rate for Payer: Blue Shield of California EPN |
$360.42
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$399.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.90
|
| Rate for Payer: Dignity Health Senior |
$521.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.07
|
| Rate for Payer: Heritage Provider Network Senior |
$380.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$295.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.00
|
| Rate for Payer: TriValley Medical Group Senior |
$307.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.90
|
| Rate for Payer: Vantage Medical Group Senior |
$521.90
|
|
|
HC DEB SUBQ AND DERMIS TISSUE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
900101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$460.50 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$415.68
|
| Rate for Payer: Heritage Provider Network Senior |
$415.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
|
