|
HC SELECT WND DEBRIDE GT 20 SQ CM OT
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM OT
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$444.75
|
| Rate for Payer: Blue Shield of California Commercial |
$361.73
|
| Rate for Payer: Blue Shield of California EPN |
$289.38
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.05
|
| Rate for Payer: Dignity Health Senior |
$504.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.07
|
| Rate for Payer: Heritage Provider Network Senior |
$367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$415.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$415.10
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$296.50
|
| Rate for Payer: TriValley Medical Group Senior |
$296.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$296.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$296.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.05
|
| Rate for Payer: Vantage Medical Group Senior |
$504.05
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM OT
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM OT
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$504.05 |
| Rate for Payer: Adventist Health Commercial |
$243.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$444.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.05
|
| Rate for Payer: Dignity Health Senior |
$504.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.07
|
| Rate for Payer: Heritage Provider Network Senior |
$367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$415.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$415.10
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.05
|
| Rate for Payer: Vantage Medical Group Senior |
$504.05
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM PT
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900411301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$504.05 |
| Rate for Payer: Adventist Health Commercial |
$243.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$444.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.05
|
| Rate for Payer: Dignity Health Senior |
$504.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.07
|
| Rate for Payer: Heritage Provider Network Senior |
$367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$415.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$415.10
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.05
|
| Rate for Payer: Vantage Medical Group Senior |
$504.05
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM PT
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$504.05 |
| Rate for Payer: Adventist Health Commercial |
$243.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$444.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.05
|
| Rate for Payer: Dignity Health Senior |
$504.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.07
|
| Rate for Payer: Heritage Provider Network Senior |
$367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$415.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$415.10
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.05
|
| Rate for Payer: Vantage Medical Group Senior |
$504.05
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM PT
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
905101304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM PT
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900411301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Blue Shield of California Commercial |
$361.73
|
| Rate for Payer: Blue Shield of California EPN |
$289.38
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.07
|
| Rate for Payer: Heritage Provider Network Senior |
$367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$277.72
|
| Rate for Payer: TriValley Medical Group Senior |
$277.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$296.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$296.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$213.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$196.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM COM
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.02 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.19
|
| Rate for Payer: Heritage Provider Network Senior |
$733.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM COM
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$444.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$670.38
|
| Rate for Payer: Heritage Provider Network Senior |
$670.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$516.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.02 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.19
|
| Rate for Payer: Heritage Provider Network Senior |
$733.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
901300070
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$444.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$670.38
|
| Rate for Payer: Heritage Provider Network Senior |
$670.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$516.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
901300070
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.02 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.19
|
| Rate for Payer: Heritage Provider Network Senior |
$733.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$444.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$670.38
|
| Rate for Payer: Heritage Provider Network Senior |
$670.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$516.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM PT
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900411300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$444.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$670.38
|
| Rate for Payer: Heritage Provider Network Senior |
$670.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$516.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM PT
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900411300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.02 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.19
|
| Rate for Payer: Heritage Provider Network Senior |
$733.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
|
|
HC SELF CARE CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8987
|
| Hospital Charge Code |
900018309
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC SELF CARE CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8987
|
| Hospital Charge Code |
900018409
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC SELF CARE CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8987
|
| Hospital Charge Code |
900018309
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SELF CARE CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8987
|
| Hospital Charge Code |
900018409
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SELF CARE D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8989
|
| Hospital Charge Code |
900018411
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
