|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
905101302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: Cigna of CA HMO |
$501.12
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903200205
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$178.77 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$565.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Central Health Plan Commercial |
$753.60
|
| Rate for Payer: Cigna of CA HMO |
$602.88
|
| Rate for Payer: Cigna of CA PPO |
$697.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$847.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$706.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903200205
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$188.40 |
| Max. Negotiated Rate |
$847.80 |
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Central Health Plan Commercial |
$753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.80
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$847.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
905101302
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
905101302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901300074
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901300074
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: Cigna of CA HMO |
$501.12
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: Cigna of CA HMO |
$501.12
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCARE COMM
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407702
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCARE COMM
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407702
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: Cigna of CA HMO |
$501.12
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: Cigna of CA HMO |
$501.12
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT COMM MCARE
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900411040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: Cigna of CA HMO |
$501.12
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT COMM MCARE
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900411040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC NON SELECT WOUND DEBRIDEMENT
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC NON SELECT WOUND DEBRIDEMENT
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: Cigna of CA HMO |
$501.12
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NON SPECIFIC ESTERASE (NSE)
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC NON SPECIFIC ESTERASE (NSE)
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$1,772.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,074.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$673.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.62
|
| Rate for Payer: Blue Distinction Transplant |
$235.20
|
| Rate for Payer: Blue Shield of California Commercial |
$242.26
|
| Rate for Payer: Blue Shield of California EPN |
$190.51
|
| Rate for Payer: Caremore Medicare Advantage |
$1,074.37
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Central Health Plan Commercial |
$313.60
|
| Rate for Payer: Cigna of CA HMO |
$250.88
|
| Rate for Payer: Cigna of CA PPO |
$290.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$333.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$352.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$294.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,772.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: InnovAge PACE Commercial |
$1,611.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,439.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: Networks By Design Commercial |
$254.80
|
| Rate for Payer: Prime Health Services Commercial |
$333.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,138.83
|
| Rate for Payer: Riverside University Health System MISP |
$1,181.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.20
|
| 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 HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC NRAS
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 81311
|
| Hospital Charge Code |
903800315
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$2,046.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$295.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,542.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.68
|
| 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: Anthem Blue Cross of CA Exchange |
$1,678.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,046.75
|
| Rate for Payer: Blue Distinction Transplant |
$201.60
|
| Rate for Payer: Blue Shield of California Commercial |
$207.65
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Caremore Medicare Advantage |
$295.79
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.68
|
| Rate for Payer: Dignity Health Media |
$295.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$399.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$295.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$295.79
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$485.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$488.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.79
|
| Rate for Payer: InnovAge PACE Commercial |
$443.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$449.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$396.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$396.36
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Prime Health Services Medicare |
$313.54
|
| Rate for Payer: Riverside University Health System MISP |
$325.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| 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 HMO Rider |
$239.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Vantage Medical Group Senior |
$295.79
|
|
|
HC NRAS
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT 81311
|
| Hospital Charge Code |
903800315
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$416.70 |
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Central Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$393.55
|
| Rate for Payer: Global Benefits Group Commercial |
$277.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$416.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.60
|
| Rate for Payer: Multiplan Commercial |
$347.25
|
| Rate for Payer: Networks By Design Commercial |
$300.95
|
| Rate for Payer: Prime Health Services Commercial |
$393.55
|
|
|
HC NUCLEIC ACID E.FAECIUM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$177.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| 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 HMO/PPO |
$177.79
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$20.05
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Media |
$20.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: InnovAge PACE Commercial |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$22.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.24
|
| Rate for Payer: United Healthcare All Other HMO |
$16.24
|
| Rate for Payer: United Healthcare HMO Rider |
$16.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID E.FAECIUM
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC NUCLEIC ACID ID ACINETOBACTER
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC NUCLEIC ACID ID ACINETOBACTER
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$177.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| 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 HMO/PPO |
$177.79
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$20.05
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Media |
$20.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: InnovAge PACE Commercial |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$22.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.24
|
| Rate for Payer: United Healthcare All Other HMO |
$16.24
|
| Rate for Payer: United Healthcare HMO Rider |
$16.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
