|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
906820172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.21
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.37
|
| Rate for Payer: Heritage Provider Network Senior |
$395.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
OP
|
$3,048.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
909081313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$609.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,093.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,590.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,676.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,286.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,981.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,590.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,590.80
|
| Rate for Payer: Dignity Health Senior |
$2,590.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,886.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,886.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,469.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$2,286.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,590.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,590.80
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
906820172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$438.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$379.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.40
|
| Rate for Payer: Dignity Health Senior |
$496.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.50
|
| Rate for Payer: Heritage Provider Network Senior |
$361.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$281.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.40
|
| Rate for Payer: Vantage Medical Group Senior |
$496.40
|
|
|
HC SELECT WND DBRD LT 20 SQ CM OT
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101300
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$612.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$583.10
|
| Rate for Payer: Heritage Provider Network Senior |
$583.10
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| 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 SELECT WND DBRD LT 20 SQ CM OT
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101300
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.15
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$637.73
|
| Rate for Payer: Heritage Provider Network Senior |
$637.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
|
|
HC SELECT WND DEBRD LT 20SQ CM PT
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$612.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$583.10
|
| Rate for Payer: Heritage Provider Network Senior |
$583.10
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| 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 SELECT WND DEBRD LT 20SQ CM PT
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.15
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$637.73
|
| Rate for Payer: Heritage Provider Network Senior |
$637.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
901300072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$828.75 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$748.08
|
| Rate for Payer: Heritage Provider Network Senior |
$748.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.25
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900400060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.41 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$828.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$718.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$939.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$939.25
|
| Rate for Payer: Dignity Health Senior |
$939.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.00
|
| Rate for Payer: Heritage Provider Network Senior |
$684.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$532.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.25
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$939.25
|
| Rate for Payer: Vantage Medical Group Senior |
$939.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900400060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$828.75 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$748.08
|
| Rate for Payer: Heritage Provider Network Senior |
$748.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.25
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
901300072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.41 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$828.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$718.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$939.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$939.25
|
| Rate for Payer: Dignity Health Senior |
$939.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.00
|
| Rate for Payer: Heritage Provider Network Senior |
$684.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$532.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.25
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$939.25
|
| Rate for Payer: Vantage Medical Group Senior |
$939.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM OT
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.41 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$461.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$298.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$407.25
|
| Rate for Payer: Blue Shield of California Commercial |
$337.20
|
| Rate for Payer: Blue Shield of California EPN |
$318.74
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$461.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$461.55
|
| Rate for Payer: Dignity Health Senior |
$461.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.12
|
| Rate for Payer: Heritage Provider Network Senior |
$336.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$271.50
|
| Rate for Payer: TriValley Medical Group Senior |
$271.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$461.55
|
| Rate for Payer: Vantage Medical Group Senior |
$461.55
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM OT
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM OT
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.41 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$461.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$298.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$407.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$461.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$461.55
|
| Rate for Payer: Dignity Health Senior |
$461.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.12
|
| Rate for Payer: Heritage Provider Network Senior |
$336.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$461.55
|
| Rate for Payer: Vantage Medical Group Senior |
$461.55
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM OT
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM PT
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900411301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.41 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$828.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$718.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$939.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$939.25
|
| Rate for Payer: Dignity Health Senior |
$939.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.00
|
| Rate for Payer: Heritage Provider Network Senior |
$684.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$532.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.25
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$939.25
|
| Rate for Payer: Vantage Medical Group Senior |
$939.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM PT
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.41 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$828.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$718.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$939.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$939.25
|
| Rate for Payer: Dignity Health Senior |
$939.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.00
|
| Rate for Payer: Heritage Provider Network Senior |
$684.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$532.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.25
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$939.25
|
| Rate for Payer: Vantage Medical Group Senior |
$939.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM PT
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$828.75 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$748.08
|
| Rate for Payer: Heritage Provider Network Senior |
$748.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.25
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM PT
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900411301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$828.75 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$748.08
|
| Rate for Payer: Heritage Provider Network Senior |
$748.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.25
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$197.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$181.42
|
| 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 SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| 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: Blue Shield of California Commercial |
$337.20
|
| Rate for Payer: Blue Shield of California EPN |
$318.74
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.12
|
| Rate for Payer: Heritage Provider Network Senior |
$336.12
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$275.15
|
| Rate for Payer: TriValley Medical Group Senior |
$275.15
|
| 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 SELECT WND DEBRIDE LT 20 SQ CM COM
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.15
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$637.73
|
| Rate for Payer: Heritage Provider Network Senior |
$637.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM COM
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$612.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$583.10
|
| Rate for Payer: Heritage Provider Network Senior |
$583.10
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| 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
|
|
