|
HC NON-GYN THIN-PREP, PG
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$321.63 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$321.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.28
|
| Rate for Payer: Blue Shield of California Commercial |
$140.82
|
| Rate for Payer: Blue Shield of California EPN |
$92.10
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: InnovAge PACE Commercial |
$101.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.89
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Prime Health Services Medicare |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$74.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.80 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$221.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$381.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$673.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$536.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.32
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Central Health Plan Commercial |
$887.20
|
| Rate for Payer: Cigna of CA HMO |
$709.76
|
| Rate for Payer: Cigna of CA PPO |
$820.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.44
|
| Rate for Payer: EPIC Health Plan Senior |
$381.07
|
| Rate for Payer: Galaxy Health WC |
$942.65
|
| Rate for Payer: Global Benefits Group Commercial |
$665.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$998.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$624.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$381.07
|
| Rate for Payer: InnovAge PACE Commercial |
$571.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.63
|
| Rate for Payer: Multiplan Commercial |
$831.75
|
| Rate for Payer: Networks By Design Commercial |
$720.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$381.07
|
| Rate for Payer: Prime Health Services Commercial |
$942.65
|
| Rate for Payer: Prime Health Services Medicare |
$403.93
|
| Rate for Payer: Riverside University Health System MISP |
$419.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$665.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$665.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$381.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Vantage Medical Group Senior |
$381.07
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.80 |
| Max. Negotiated Rate |
$998.10 |
| Rate for Payer: Adventist Health Commercial |
$221.80
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Central Health Plan Commercial |
$887.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.60
|
| Rate for Payer: EPIC Health Plan Senior |
$443.60
|
| Rate for Payer: Galaxy Health WC |
$942.65
|
| Rate for Payer: Global Benefits Group Commercial |
$665.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$998.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$686.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.80
|
| Rate for Payer: Multiplan Commercial |
$831.75
|
| Rate for Payer: Networks By Design Commercial |
$720.85
|
| Rate for Payer: Prime Health Services Commercial |
$942.65
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
915352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.13 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.14
|
| Rate for Payer: Blue Shield of California Commercial |
$417.42
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.13
|
| Rate for Payer: InnovAge PACE Commercial |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Riverside University Health System MISP |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
915352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.42
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
905352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.13 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.14
|
| Rate for Payer: Blue Shield of California Commercial |
$417.42
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.13
|
| Rate for Payer: InnovAge PACE Commercial |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Riverside University Health System MISP |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
905352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.42
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
915354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
915354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.24
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.42
|
| Rate for Payer: InnovAge PACE Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
905354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.24
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.42
|
| Rate for Payer: InnovAge PACE Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
905354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.02
|
| 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 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 |
$377.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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: 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: InnovAge PACE Commercial |
$321.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.10
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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-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: 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 Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| 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
|
$1,245.00
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$830.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.65
|
| 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
|
$1,035.00
|
|
|
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 |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$628.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.96
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| 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
|
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 |
$628.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$607.86
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
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 |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$510.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$830.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,058.25
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
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 |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$628.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.96
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| 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 |
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 |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$628.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.96
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| 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
|
|
