|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$1,321.50 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,210.49
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
|
|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
OP
|
$1,762.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,210.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,497.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$969.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,321.50
|
| 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 |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,145.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,497.70
|
| Rate for Payer: Dignity Health Senior |
$1,497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$849.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| 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 |
$1,497.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,497.70
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903200205
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$146.78
|
| Rate for Payer: 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 NON-SELECTIVE WOUND DEBRIDE
|
Facility
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903200205
|
|
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 NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
OP
|
$783.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$587.25 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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 |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$508.95
|
| 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 |
$508.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.68
|
| Rate for Payer: Heritage Provider Network Senior |
$484.68
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| 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 |
$587.25
|
| 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 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 |
901300074
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$141.72 |
| Max. Negotiated Rate |
$587.25 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.92
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.09
|
| Rate for Payer: Heritage Provider Network Senior |
$530.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
|
|
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 |
$80.51 |
| Max. Negotiated Rate |
$587.25 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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 |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$508.95
|
| 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 |
$508.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.68
|
| Rate for Payer: Heritage Provider Network Senior |
$484.68
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| 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 |
$587.25
|
| 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 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 |
$141.72 |
| Max. Negotiated Rate |
$587.25 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.92
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.09
|
| Rate for Payer: Heritage Provider Network Senior |
$530.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
|
|
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 |
$80.51 |
| Max. Negotiated Rate |
$587.25 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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 |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$508.95
|
| 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 |
$508.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.68
|
| Rate for Payer: Heritage Provider Network Senior |
$484.68
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| 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 |
$587.25
|
| 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 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 |
$141.72 |
| Max. Negotiated Rate |
$587.25 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.92
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.09
|
| Rate for Payer: Heritage Provider Network Senior |
$530.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT
|
Facility
OP
|
$359.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$475.27 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$246.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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 |
$161.55
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.35
|
| 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 |
$233.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.22
|
| Rate for Payer: Heritage Provider Network Senior |
$222.22
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.75
|
| 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 |
$269.25
|
| 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 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
|
$359.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$246.63
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.04
|
| Rate for Payer: Heritage Provider Network Senior |
$243.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.75
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
|
|
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 |
$141.72 |
| Max. Negotiated Rate |
$587.25 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.92
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.09
|
| Rate for Payer: Heritage Provider Network Senior |
$530.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
|
|
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 |
$80.51 |
| Max. Negotiated Rate |
$587.25 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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 |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$508.95
|
| 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 |
$508.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.68
|
| Rate for Payer: Heritage Provider Network Senior |
$484.68
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| 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 |
$587.25
|
| 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 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 SELECT WOUND DEBRIDEMENT
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
761
|
| 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 NON SELECT WOUND DEBRIDEMENT
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Blue Shield of California Commercial |
$362.66
|
| Rate for Payer: Blue Shield of California EPN |
$342.81
|
| 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 |
$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 |
$361.50
|
| Rate for Payer: Heritage Provider Network Senior |
$361.50
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| 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 |
$438.00
|
| 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 NON SELECT WOUND DEBRIDEMENT
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$475.27 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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 |
$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 |
$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 |
$379.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.50
|
| Rate for Payer: Heritage Provider Network Senior |
$361.50
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| 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 |
$438.00
|
| 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 NON SELECT WOUND DEBRIDEMENT
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
430
|
| 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 NON SPECIFIC ESTERASE (NSE)
|
Facility
OP
|
$392.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.01 |
| Max. Negotiated Rate |
$2,041.30 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$266.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.01
|
| Rate for Payer: Blue Shield of California Commercial |
$243.43
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: Dignity Health Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,074.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.65
|
| Rate for Payer: Heritage Provider Network Senior |
$242.65
|
| Rate for Payer: Humana Medicare |
$1,074.37
|
| Rate for Payer: IEHP Medi-Cal |
$107.30
|
| Rate for Payer: IEHP Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,041.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,353.71
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,074.37
|
| Rate for Payer: TriValley Medical Group Senior |
$1,074.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| 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 NON SPECIFIC ESTERASE (NSE)
|
Facility
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$195.48 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$741.96
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$731.16
|
| Rate for Payer: Heritage Provider Network Senior |
$731.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
|
|
HC NRAS
|
Facility
OP
|
$336.00
|
|
|
Service Code
|
CPT 81311
|
| Hospital Charge Code |
903800315
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.82 |
| Max. Negotiated Rate |
$1,930.64 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$611.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$230.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$443.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$295.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,930.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,653.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,292.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$218.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.37
|
| Rate for Payer: Dignity Health Senior |
$295.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.98
|
| Rate for Payer: Heritage Provider Network Senior |
$207.98
|
| Rate for Payer: Humana Medicare |
$295.79
|
| Rate for Payer: IEHP Medi-Cal |
$369.14
|
| Rate for Payer: IEHP Medicare Advantage |
$295.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$562.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$349.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$372.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.70
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$295.79
|
| Rate for Payer: TriValley Medical Group Senior |
$295.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$319.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.45
|
| 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 |
$83.80 |
| Max. Negotiated Rate |
$347.25 |
| Rate for Payer: Adventist Health Commercial |
$92.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$318.08
|
| Rate for Payer: Cash Price |
$208.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$313.45
|
| Rate for Payer: Heritage Provider Network Senior |
$313.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.75
|
| Rate for Payer: Multiplan Commercial |
$347.25
|
|
|
HC NUCLEIC ACID E.FAECIUM
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$167.70 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.70
|
| Rate for Payer: Blue Shield of California Commercial |
$156.63
|
| Rate for Payer: Blue Shield of California EPN |
$122.45
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$20.05
|
| Rate for Payer: IEHP Medi-Cal |
$25.33
|
| Rate for Payer: IEHP Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| 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 |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC NUCLEIC ACID ID ACINETOBACTER
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
