|
HC D & C 1ST TRIMESTER
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,988.80
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
|
|
HC D & C 1ST TRIMESTER
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,831.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,264.81
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,872.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,872.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,213.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,320.50
|
| Rate for Payer: TriValley Medical Group Senior |
$2,320.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,320.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC D & C 2ND TRIMESTER
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
910400030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,988.80
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
|
|
HC D & C 2ND TRIMESTER
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
910400030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,831.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,264.81
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,872.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,872.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,213.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,320.50
|
| Rate for Payer: TriValley Medical Group Senior |
$2,320.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,320.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC DCMPRSN PERC W PRTL RMV OF LF INCL LMNTY
|
Facility
|
IP
|
$23,332.00
|
|
|
Service Code
|
CPT 62330
|
| Hospital Charge Code |
906811875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,223.09 |
| Max. Negotiated Rate |
$17,499.00 |
| Rate for Payer: Adventist Health Commercial |
$4,666.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,025.81
|
| Rate for Payer: Cash Price |
$10,499.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,795.76
|
| Rate for Payer: Heritage Provider Network Senior |
$15,795.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,223.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,833.00
|
| Rate for Payer: Multiplan Commercial |
$17,499.00
|
|
|
HC DCMPRSN PERC W PRTL RMV OF LF INCL LMNTY
|
Facility
|
OP
|
$23,332.00
|
|
|
Service Code
|
CPT 62330
|
| Hospital Charge Code |
906811875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,223.09 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Adventist Health Commercial |
$4,666.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,419.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$10,499.40
|
| Rate for Payer: Cash Price |
$10,499.40
|
| Rate for Payer: Cash Price |
$10,499.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,165.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,999.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,442.51
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,223.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,833.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$17,499.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,666.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,666.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC DCMPRSN PERC W PRTL RMV OF LF INCL LMNTY ADD IS LUMBAR
|
Facility
|
OP
|
$11,666.00
|
|
|
Service Code
|
CPT 62331
|
| Hospital Charge Code |
906811576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,111.55 |
| Max. Negotiated Rate |
$9,916.10 |
| Rate for Payer: Adventist Health Commercial |
$2,333.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,209.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,916.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,416.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,749.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,835.33
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,582.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,916.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,916.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,916.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,999.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,221.25
|
| Rate for Payer: Heritage Provider Network Senior |
$7,221.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,564.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,111.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,916.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,166.20
|
| Rate for Payer: Multiplan Commercial |
$8,749.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,833.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,833.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,916.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,916.10
|
| Rate for Payer: Vantage Medical Group Senior |
$9,916.10
|
|
|
HC DCMPRSN PERC W PRTL RMV OF LF INCL LMNTY ADD IS LUMBAR
|
Facility
|
IP
|
$11,666.00
|
|
|
Service Code
|
CPT 62331
|
| Hospital Charge Code |
906811576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,111.55 |
| Max. Negotiated Rate |
$8,749.50 |
| Rate for Payer: Adventist Health Commercial |
$2,333.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,512.90
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,897.88
|
| Rate for Payer: Heritage Provider Network Senior |
$7,897.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,111.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,916.50
|
| Rate for Payer: Multiplan Commercial |
$8,749.50
|
|
|
HC D DIMER
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.87
|
| Rate for Payer: Heritage Provider Network Senior |
$165.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
|
|
HC D DIMER
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$96.59 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.59
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.70
|
| Rate for Payer: Blue Shield of California EPN |
$65.70
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$151.66
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$116.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC D-DIMER
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900912043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$96.59 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.59
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.70
|
| Rate for Payer: Blue Shield of California EPN |
$65.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC D-DIMER
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900912043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.64
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC DEB MUSCLE AND OR FASCIA EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
900101492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$408.70
|
| Rate for Payer: Blue Shield of California EPN |
$326.96
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$435.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$569.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.73
|
| Rate for Payer: Heritage Provider Network Senior |
$414.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$319.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$469.00
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$335.00
|
| Rate for Payer: TriValley Medical Group Senior |
$335.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$335.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$335.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.50
|
| Rate for Payer: Vantage Medical Group Senior |
$569.50
|
|
|
HC DEB MUSCLE AND OR FASCIA EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
900101492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$502.50 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$431.48
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.59
|
| Rate for Payer: Heritage Provider Network Senior |
$453.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.50
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
|
|
HC DEB OF FX SKIN MUSCLE
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$663.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$510.15
|
| Rate for Payer: Blue Shield of California EPN |
$405.97
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$512.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$644.40
|
| Rate for Payer: TriValley Medical Group Senior |
$644.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC DEB OF FX SKIN MUSCLE
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$691.66
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$691.66
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$663.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$655.14
|
| Rate for Payer: Blue Shield of California EPN |
$524.11
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,735.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.81
|
| Rate for Payer: Heritage Provider Network Senior |
$4,595.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,098.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,109.55
|
| Rate for Payer: TriValley Medical Group Senior |
$4,109.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$663.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$805.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$655.14
|
| Rate for Payer: Blue Shield of California EPN |
$524.11
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.81
|
| Rate for Payer: Heritage Provider Network Senior |
$664.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$512.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$751.80
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$537.00
|
| Rate for Payer: TriValley Medical Group Senior |
$537.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$537.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$537.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$691.66
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.12
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$109.25
|
| Rate for Payer: Blue Shield of California EPN |
$86.94
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$109.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Senior |
$138.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,198.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$921.50
|
| Rate for Payer: Blue Shield of California EPN |
$733.32
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,261.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,313.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,313.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$925.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,164.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,164.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.14 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,249.36
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,313.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,313.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.14 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,249.36
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,313.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,313.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
|
