|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
IP
|
$10,287.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,468.88 |
| Max. Negotiated Rate |
$8,743.95 |
| Rate for Payer: Cash Price |
$4,629.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,114.80
|
| Rate for Payer: Galaxy Health WC |
$8,743.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,861.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,919.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,468.88
|
| Rate for Payer: Multiplan Commercial |
$8,229.60
|
| Rate for Payer: Networks By Design Commercial |
$6,686.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,743.95
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$10,287.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$677.65 |
| Max. Negotiated Rate |
$8,743.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,743.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,657.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,657.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,172.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$4,629.15
|
| Rate for Payer: Cash Price |
$4,629.15
|
| Rate for Payer: Cigna of CA PPO |
$7,612.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,743.95
|
| Rate for Payer: Dignity Health Media |
$8,743.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,743.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,114.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,114.80
|
| Rate for Payer: Galaxy Health WC |
$8,743.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,172.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,715.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,861.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$677.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,468.88
|
| Rate for Payer: Multiplan Commercial |
$8,229.60
|
| Rate for Payer: Networks By Design Commercial |
$6,686.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,743.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,172.20
|
| 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 |
$8,743.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,743.95
|
| Rate for Payer: Vantage Medical Group Senior |
$8,743.95
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$468.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.32
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$468.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$397.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.83
|
| Rate for Payer: Blue Distinction Transplant |
$280.80
|
| Rate for Payer: Blue Shield of California Commercial |
$344.92
|
| Rate for Payer: Blue Shield of California EPN |
$273.31
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna of CA HMO |
$299.52
|
| Rate for Payer: Cigna of CA PPO |
$346.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$397.80
|
| Rate for Payer: Dignity Health Media |
$397.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$397.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$187.20
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$351.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.32
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$280.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.00
|
| Rate for Payer: United Healthcare All Other HMO |
$234.00
|
| Rate for Payer: United Healthcare HMO Rider |
$234.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$397.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$397.80
|
| Rate for Payer: Vantage Medical Group Senior |
$397.80
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$845.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$718.25 |
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$676.00
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$845.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$718.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$554.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$718.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$464.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$503.45
|
| Rate for Payer: Blue Distinction Transplant |
$507.00
|
| Rate for Payer: Blue Shield of California Commercial |
$622.76
|
| Rate for Payer: Blue Shield of California EPN |
$493.48
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cigna of CA HMO |
$540.80
|
| Rate for Payer: Cigna of CA PPO |
$625.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$718.25
|
| Rate for Payer: Dignity Health Media |
$718.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$718.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$633.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$676.00
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Other HMO |
$422.50
|
| Rate for Payer: United Healthcare HMO Rider |
$422.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$718.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$718.25
|
| Rate for Payer: Vantage Medical Group Senior |
$718.25
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$1,104.00
|
|
| Hospital Charge Code |
909201305
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$264.96 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.60
|
| Rate for Payer: Galaxy Health WC |
$938.40
|
| Rate for Payer: Global Benefits Group Commercial |
$662.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$736.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.96
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: Networks By Design Commercial |
$717.60
|
| Rate for Payer: Prime Health Services Commercial |
$938.40
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$968.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$822.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$634.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$822.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$532.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$576.73
|
| Rate for Payer: Blue Distinction Transplant |
$580.80
|
| Rate for Payer: Blue Shield of California Commercial |
$713.42
|
| Rate for Payer: Blue Shield of California EPN |
$565.31
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna of CA HMO |
$619.52
|
| Rate for Payer: Cigna of CA PPO |
$716.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$822.80
|
| Rate for Payer: Dignity Health Media |
$822.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$822.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$387.20
|
| Rate for Payer: Galaxy Health WC |
$822.80
|
| Rate for Payer: Global Benefits Group Commercial |
$580.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$726.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$645.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.32
|
| Rate for Payer: Multiplan Commercial |
$774.40
|
| Rate for Payer: Networks By Design Commercial |
$629.20
|
| Rate for Payer: Prime Health Services Commercial |
$822.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$580.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$580.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$484.00
|
| Rate for Payer: United Healthcare All Other HMO |
$484.00
|
| Rate for Payer: United Healthcare HMO Rider |
$484.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$822.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$822.80
|
| Rate for Payer: Vantage Medical Group Senior |
$822.80
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$968.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$822.80 |
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.20
|
| Rate for Payer: Galaxy Health WC |
$822.80
|
| Rate for Payer: Global Benefits Group Commercial |
$580.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$645.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.32
|
| Rate for Payer: Multiplan Commercial |
$774.40
|
| Rate for Payer: Networks By Design Commercial |
$629.20
|
| Rate for Payer: Prime Health Services Commercial |
$822.80
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$1,104.00
|
|
| Hospital Charge Code |
909201305
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$264.96 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$724.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$607.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$657.76
|
| Rate for Payer: Blue Distinction Transplant |
$662.40
|
| Rate for Payer: Blue Shield of California Commercial |
$813.65
|
| Rate for Payer: Blue Shield of California EPN |
$644.74
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna of CA HMO |
$706.56
|
| Rate for Payer: Cigna of CA PPO |
$816.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$938.40
|
| Rate for Payer: Dignity Health Media |
$938.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$441.60
|
| Rate for Payer: Galaxy Health WC |
$938.40
|
| Rate for Payer: Global Benefits Group Commercial |
$662.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$736.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.96
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: Networks By Design Commercial |
$717.60
|
| Rate for Payer: Prime Health Services Commercial |
$938.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$662.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$662.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Other HMO |
$552.00
|
| Rate for Payer: United Healthcare HMO Rider |
$552.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.40
|
| Rate for Payer: Vantage Medical Group Senior |
$938.40
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$32.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.37
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.83
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Media |
$2.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2.70
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
909081312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$496.40 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.16
|
| Rate for Payer: Multiplan Commercial |
$467.20
|
| Rate for Payer: Networks By Design Commercial |
$379.60
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
909081312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$350.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna of CA PPO |
$432.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.40
|
| Rate for Payer: Dignity Health Media |
$496.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$438.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.16
|
| Rate for Payer: Multiplan Commercial |
$467.20
|
| Rate for Payer: Networks By Design Commercial |
$379.60
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.40
|
| 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 |
$496.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.40
|
| Rate for Payer: Vantage Medical Group Senior |
$496.40
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
909081313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$496.40 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.16
|
| Rate for Payer: Multiplan Commercial |
$467.20
|
| Rate for Payer: Networks By Design Commercial |
$379.60
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
909081313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$350.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna of CA PPO |
$432.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.40
|
| Rate for Payer: Dignity Health Media |
$496.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$438.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.16
|
| Rate for Payer: Multiplan Commercial |
$467.20
|
| Rate for Payer: Networks By Design Commercial |
$379.60
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.40
|
| 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 |
$496.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.40
|
| Rate for Payer: Vantage Medical Group Senior |
$496.40
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
903501030
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$939.25 |
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$884.00
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
903501030
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$607.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$663.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cigna of CA HMO |
$707.20
|
| Rate for Payer: Cigna of CA PPO |
$817.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$939.25
|
| Rate for Payer: Dignity Health Media |
$939.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$939.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$828.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$884.00
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$939.25
|
| Rate for Payer: Vantage Medical Group Senior |
$939.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900400060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$607.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$663.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cigna of CA HMO |
$707.20
|
| Rate for Payer: Cigna of CA PPO |
$817.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$939.25
|
| Rate for Payer: Dignity Health Media |
$939.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$939.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$828.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$884.00
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$939.25
|
| Rate for Payer: Vantage Medical Group Senior |
$939.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
901300072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$607.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$663.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cigna of CA HMO |
$707.20
|
| Rate for Payer: Cigna of CA PPO |
$817.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$939.25
|
| Rate for Payer: Dignity Health Media |
$939.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$939.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$828.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$884.00
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$939.25
|
| Rate for Payer: Vantage Medical Group Senior |
$939.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
901300072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$939.25 |
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$884.00
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900400060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$939.25 |
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$884.00
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$226.08 |
| Max. Negotiated Rate |
$800.70 |
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.80
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.08
|
| Rate for Payer: Multiplan Commercial |
$753.60
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.08 |
| Max. Negotiated Rate |
$800.70 |
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.80
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.08
|
| Rate for Payer: Multiplan Commercial |
$753.60
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.77 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$565.20
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna of CA PPO |
$697.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$706.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$753.60
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$471.00
|
| Rate for Payer: United Healthcare All Other HMO |
$471.00
|
| Rate for Payer: United Healthcare HMO Rider |
$471.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
