|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$482.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$311.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.03
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Central Health Plan Commercial |
$514.40
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$546.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$578.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$450.10
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Riverside University Health System MISP |
$257.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.55
|
| Rate for Payer: Vantage Medical Group Senior |
$546.55
|
|
|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Central Health Plan Commercial |
$514.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$578.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.60
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
905101302
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$424.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$602.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903200205
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$249.00 |
| Max. Negotiated Rate |
$1,120.50 |
| Rate for Payer: Adventist Health Commercial |
$249.00
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Central Health Plan Commercial |
$996.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$871.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$498.00
|
| Rate for Payer: Galaxy Health WC |
$1,058.25
|
| Rate for Payer: Global Benefits Group Commercial |
$747.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,120.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$790.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$734.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| Rate for Payer: Networks By Design Commercial |
$809.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,058.25
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903200205
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.43 |
| Max. Negotiated Rate |
$1,120.50 |
| Rate for Payer: Adventist Health Commercial |
$510.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Central Health Plan Commercial |
$996.00
|
| Rate for Payer: Cigna of CA HMO |
$796.80
|
| Rate for Payer: Cigna of CA PPO |
$921.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$871.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,058.25
|
| Rate for Payer: Global Benefits Group Commercial |
$747.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,120.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$790.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| Rate for Payer: Networks By Design Commercial |
$809.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,058.25
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$747.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
905101302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$424.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
905101302
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
905101302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901300074
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$424.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$424.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901300074
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCARE COMM
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407702
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$424.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCARE COMM
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407702
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$424.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT COMM MCARE
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900411040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$424.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT COMM MCARE
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900411040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC NON SELECT WOUND DEBRIDEMENT
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC NON SELECT WOUND DEBRIDEMENT
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$424.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NON SPECIFIC ESTERASE (NSE)
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC NON SPECIFIC ESTERASE (NSE)
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$1,709.80 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$762.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$762.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.52
|
| Rate for Payer: Blue Shield of California Commercial |
$241.29
|
| Rate for Payer: Blue Shield of California Commercial |
$665.28
|
| Rate for Payer: Blue Shield of California EPN |
$152.05
|
| Rate for Payer: Blue Shield of California EPN |
$419.23
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$245.12
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$283.42
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC NRAS
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 81311
|
| Hospital Charge Code |
903800315
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$2,332.83 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$295.79
|
| Rate for Payer: Adventist Health Medi-Cal |
$295.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,542.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,542.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,678.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,678.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,332.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,332.83
|
| Rate for Payer: Blue Shield of California Commercial |
$284.76
|
| Rate for Payer: Blue Shield of California Commercial |
$206.64
|
| Rate for Payer: Blue Shield of California EPN |
$179.44
|
| Rate for Payer: Blue Shield of California EPN |
$130.22
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$229.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.05
|
| Rate for Payer: EPIC Health Plan Senior |
$325.37
|
| Rate for Payer: EPIC Health Plan Senior |
$325.37
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$485.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$485.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$407.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$407.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$208.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$449.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$449.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$396.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$396.36
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.79
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Prime Health Services Medicare |
$313.54
|
| Rate for Payer: Prime Health Services Medicare |
$313.54
|
| Rate for Payer: Riverside University Health System MISP |
$325.37
|
| Rate for Payer: Riverside University Health System MISP |
$325.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.59
|
| Rate for Payer: United Healthcare All Other HMO |
$239.59
|
| Rate for Payer: United Healthcare All Other HMO |
$239.59
|
| Rate for Payer: United Healthcare HMO Rider |
$239.59
|
| Rate for Payer: United Healthcare HMO Rider |
$239.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Vantage Medical Group Senior |
$295.79
|
| Rate for Payer: Vantage Medical Group Senior |
$295.79
|
|
|
HC NRAS
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 81311
|
| Hospital Charge Code |
903800315
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
HC NUCLEIC ACID E.FAECIUM
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.64
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California Commercial |
$108.36
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Blue Shield of California EPN |
$68.28
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.05
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$22.05
|
| Rate for Payer: Riverside University Health System MISP |
$22.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
